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N306 Patho/Pharm
Infectious Diseases & Anti-Infecive Medications
57
Nursing
Undergraduate 3
11/07/2009

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Cards

Term
What are the 5 types of pathogens?
Definition
1. Bacteria
2. Atypicals (prions, mycoplasmas)
3. Virus
4. Fungi
5. Parasites
Term
What factors influence the severity of a disease?
Definition
Host response, portal of entry, pathogen "load", organism virulence, organism characteristics
Term
What are some bacterial pathogenic characteristics?
Definition
Rigid cell wall, reproduce by direct cell division, aerobic or anaerobic, some form spores, classified by shape & staining
Term
Why are mycoplasmas difficult to treat with antibiotics?
Definition
No rigid cell wall (where many abx's act)
Term
Characteristics of Rickettsiae & Chlamydiae
Definition
Rigid cell wall, intracellular obligate, may be transmitted by arthropod
Term
What are viral pathogenic characteristics?
Definition
Intracellular obligates (need host for reproduction), no cell structure, some have lipoprotein coat
Term
What are fungi pathogenic characteristics?
Definition
Ubiquitous in the environment, cause problems in immunocompromised ppl, common cause of tinea
Term
What are the three types of parasites?
Definition
1. Protozoa - unicellular; malaria, dysentery, giardia
2. Helminths - worm like
3. parasitic arthropod - can be vectors of cause own problems; ticks, lice
Term
Which type of microorganism is responsible for the majority of infectious human illnesses?
Definition
Viruses
Term
How do antimicrobials destroy infections organisms w/o damaging host cells?
Definition
By capitalizing on unique characteristics of the infection organisms' structure, requirements, or reproduction.
Term
What factors might make it difficult for a drug to effectively work again a microorganism?
Definition
Blood brain barrier, sequestration of organism (abscess or sinusitis, "clump"), colonization of foreign material in body ("distraction")
Term
What factors affect drug treatment?
Definition
*Age - very young = immature system (no sulfa /tetracycline)
*Pregnancy/lactation = cross into placenta/breast milk
*Allergic rx
*Genetic Factors
Term
What are the 3 possible antibiotic mechanisms of action?
Definition
1. Disrupt cell wall membrane = allow fluid in and cause cell lysis (pcn/cephalosporin)
2. Inhibit folic acid synthesis (sulfonamides)
3. Disrupt bacterial protein synthesis = act on ribosomes of bacteria
Term
How does acquired resistance in organisms occur?
Definition
* Microbes create or improve drug-metabolizing enzyme
* Microbes stop taking up the drug
* Microbe receptors stop binding w/ drug
* Microbes may synthesize compounds to counter drug action
* spontaneous mutation
* bacterial conjugation = sharing DNA to broaden resistance
Term
What are the three major consequences of drug resistance?
Definition
1. Suprainfections = secondary to primary infection
2. Nosocomial infecitons
3. Community resistance
Term
What are the CDC guidelines for minimizing drug resistance? (11 things!)
Definition
1. Prevent infections = vaccines, remove caths
2. Target pathogens
3. Access the experts
4. Practice antimicrobial control
5. Use local data
6. Treat infection, not contamination
7. Treat infection, not colonization
8. Know when to say no to Vanco
9. Stop tx when infection is cured
10. Isolate the pathogen
11. Break the chain of contagion
Term
What 3 factors are considered in antibiotic selection?
Definition
1. Identity of organism (microscopy, stains)
2. Susceptibility of organism (C&S)
3. Host (allergies, tx preparation, ADR, cost, compliance, ocp)
Term
Why do many abxs reduce contraceptive efficacy?
Definition
Estrogens & many abx are metabolized by CYP450 = compete for metabolic enzymes = less estrogen metabolized & available.
Term
What characterizes beta lactam abx?
What is their mechanism of action?
Examples?
Definition
presence of beta lactam ring in abx chemical structure
weakens becterial cell wall = increase osmotic pressure = pull water in = lyse cell
pcns, cephalosporins, related drugs
Term
How do bacteria become resistant to beta lactam abx?
Definition
* bacteria produce enzyme beta lactamase
* cleaves beta lactam ring & inactivates drug
Term
When are abx used prophylactically?
Definition
* Prior to surgery (cardio, orthopedic, GI)
* Prevention of bacterial endocarditis & cardiac valve disease
* Neutropenia & immune compromise
* chronic UTI
Term
What is the beta lactam prototype?
Uses?
Drug Facts?
Definition
Penicillin, Gram+ cocci (esp. strep), neisseria meningitis, syphilis, prophylaxis bacterial endocarditis, many orgs. resistant (staph)
Term
How is Pen G administered, absorbed, excreted?
Definition
IM (very unpleasant) or IV, absorbed based on preparation, renal excretion
Term
What other varieties of pcns are there?
Definition
Oral - Pn V, Pen VK
Penicillinase resistant pcns - narrow specturm against staph - Dicloxicillin, methiillin
Broad spectrum pcs - inactivated by beta lactamases - ampicillin, amoxicillin
Extended spectrum pcn - hospital use - tecracillin
Pcn mixed w beta lactamase inhib
Term
What's the deal with Cephalosporins?
Definition
Similar to pcns
Disrupt cell wall synthesis
Often resistant to bacterial beta lactamase
Most widely used abx b/c broud specturm
Each "generation" more effective
Term
Cephalosporin route? excretion? considerations?
Definition
Route based on individual drug
Renal excretion
Not given to pcn allergic cts
Can cause disulfiram rx c ETOH & bleeding
IV irritant
Term
What are the two "big gun" beta lactam abx? administration? excretion?
Definition
IV Only
Renal excretion
Imipenem (Primaxin)
Vancomycin - drug of choice MRSA c.diff
Ototoxic side effects, thrombophlembitis, peak & trough levels
Term
What is Clostridium difficele (C. difficele)?
Definition
Gram+ spore-forming bacteria in normal gut flora in 3% of ppl
Abx disrupt normal flora = C.diff overgrow
Toxins bind to interstinal mucosa = hemorrhage, inflamm, diarrhea
Usually stops c abx tx end
Most cases Nosocomial
Tx c Vancomycin = PO b/c gut flora
Term
What is Tetracyclines mechanism of action?
Broad or narrow spectrum?
Definition
Inhibit bacterial protein synthesis & suppress bacterial reproduction = bacteriostatic
Broud spectrum
Term
What is the tetracycline minocycline commonly used for?
Definition
Acne
Term
What is tetracycline a first line drug for?
What is Doxycycline commonly used for?
Definition
Mycoplasma pneumonia, Rocky Mountain spotted fever, Typhus, Periodontal disease
Doxycycline = Chlymydia
Term
What are some adverse effects of tetracyclines?
Definition
GI Irritation = gastritis, N/V/D
Cannot be give c/in 2 hrs of milk, CA+, Iron, Mg or Alum.
Stains teeth = brown
Suprainfection = candida, C.diff
Photosensitivity
Hepatotoxicity
Term
What are macrolides mechanism of action?
Broad or narrow spectrum?
Three examples?
Definition
Inhibit bacterial protein synthesis
Broad spectrum
1. Erythromycin
2. Clarithromycin
3. Azithromycin (Z-pac)
Term
When are macrolides commonly used?
Definition
Cts allergic to pcn
Legionnaires disease
Pertussis
Diptheria
Chlamydia
Mycoplasma
Strep peumonia
Term
Benefits/Adverse effects of Erythromycin?
Definition
Cheap
N/V/D
Give c meals
CYP 450 interactions - NO c antihist, theophylline, carbamazepine, WARFARIN = Inc. risk c antiarrhythic rx, Ca channel blackers, antifungals, protease inhib
Term
Benefit/Adverse effects of Azithromycin
Definition
Cheap-er
No GI effects
NOT administered c food
Slow elimination (bile) = loading dose ok
Short course of tx
Term
What is the risk of using Clindamycin?
What is it still the drug of choice for?
Definition
Pseudomembranous colitis
Gas Gangrene
Term
What are aminoglycocides mechanism of action?
Broad or narrow spectrum?
Major ADRs?
Administration?
Examples?
Definition
Disrupt bacterial protein synth = directly kill cells = bacteriocidal
Narrow spectrum (gram- aerobic)
Ototoxic & Renal toxic = peak & trough levels
IV administration unless in lumen of gut
Gentamycin, streptomycin, Amikacin
Term
Aminoglycoside prototype?
What is is used against?
ADRs?
Definition
Gentamycin
E.Coli, Klebsiella pneumoniae, Serratia, Proteus, Pseudomonas
Potent Oto & nephro toxicity = irreversible hearing damage = monitor for high trough levels
Increases neuromuscular blockade
Term
Gentamycin drug-drug interactions?
Definition
Other ototoxic or nephrotoxic drugs (Furosimide)
Often given c pcns, but cannot be mixed in same solution
Peak & trough levels Q30min c IV admin.
Term
Why are sulfonamides so special?
Definition
First abx ever
Cured preciously fatal diseases
Led to understanding of internal drug metabolism and bioavailability
Widespread resistance today
Term
What are sulfonamides mechanism of action?
Common uses?
Definition
Disrupt folic acid synthesis by bacterial cell
UTI
Sinusitis
MRSA
Off-label = headlice
Term
What are the adverse effects of sulfonamides?
Definition
Hypersensitivity = rash, fever = STOP tx
Cross sensitivities = thiazide & loop diuretics, diamox
Blood dyscrasias = anemias
Kernicterus = bilirubin collects in brain = NEVER given to infants <2mo.
Renal damage = increase fluid intake
Photosensitivity
Term
What drug works synergistically with sulfa?
Definition
Trimethoprin
Term
What drug is used as a urinary tract antiseptic?
Definition
Nitrofurantoin (Macrodantin) - works c mild cases
Broad spectrum bacteriostatic
Collects in urine
Term
What are fluoroquinolones used for?
Prototype?
What is it a DOC for?
Definition
Broad spectrum bacteriocidal
Infections in resp. tract, urinary tract, bone, joint, soft tissue
Ciprofloxin
DOC for anthrax
Term
What are the adverse effects of Ciprofloxin?
Drug interactions?
Definition
GI distress
Suprainfection
Tendon Rupture
Interacts c Cationic compounts = antacids, iron, dairy
Theophylline
Coumadin
Term
What is metronidazole (Flagyl) used against?
What is is the DOC for?
Prophylactic use?
Other uses?
Definition
Protozoal species
Only against obligate anaerobes
DOC for giardia, trickomonas, gardnerella, amebiasis, C.diff colitis
Prophylactic before GI or vaginal surgery
Multi drug combo for H. pylori
Term
What are the ADRs of Metronidazole (Flagyl)?
Drug interactions?
Definition
Metallic taste
GI distress (N/V)
Dark color to urine
Rare CNS paresthesias
Disulfiram reaction c ETOH
Term
Fugal infections - systemic vs. topical?
Definition
Systemic rare = most common c AIDS/transplants = very dangerous
Topical common = tinea, onchomycosis, candida
Term
What is the anti-fungal prototype?
Mechanism of action?
Administration route?
Definition
Amphotericin B
Binds to sterol compounds in cell membrane (sometimes c human cholesterol too)
IV only
Term
What are the adverse effects of Amphotericin B?
Definition
Infusion reaction = fever, chills, headache = prtreat c diphenhydramine
Thrombophlebitis
Nephrotoxicity
Hypokalemia
Bone marrow suppression
Term
What are the 'safer' antifunals?
Administration?
Broad or narrow spectrum?
Definition
Itraconozole (Sporanox)
Fluconazole (Diflucan)
IV or PO
Broad spectrum
Term
What are the ADRs of Sporanox or Diflucan?
Definition
Cardiac suppression
Hepatic damage
CYP450 metabolism interactions c other drugs = antihistamines
Term
What interesting ADR occurs with antifungal ketoconazole (Nizoral)?
Drug interactions?
Definition
Sex hormone effects = ED, decreased libido irreg menses
Aminoglycosides
Flucytosine
Term
What drug is used to treat Hansens Disease (leprosy)?
ADR?
Drug interactions?
Definition
Dapsone
Discoloration of saliva, urine
Hepatotoxicity
GI distress
Warfarin, oc's protease inhibitors, rifampin
Term
What drugs are commonly used for TB?
Definition
Isoniazid (INH)
Rifampin
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