| Something capable of acting against infection,
by inhibiting the spread of an infectious agent or by killing the
infectious agent outright.
is a general term that encompasses
antibacterial (antibiotics), antifungals, antimalarials,
antituberculosis agents (antimycobacterials), antehelmintics,
antiprotozoans and antivirals. | Anti-infective |
| When or in what year did Paul Ehrlich (March 1854-August 1915) developed a synthetic that is effective only against infection causing cells, not human cells? | 1920 |
| In 1920's, who developed a synthetic that is effective only against infection causing cells, not human cells. | Paul Ehrlich (March 1854-August 1915) |
| Therapeutic Actions: 1: | Interference with the normal function of the
invading organisms to prevent from reproducing. |
| Therapeutic Actions: 2 | to cause cell death without affecting the host cell |
| Therapeutic Actions: 3 | Interfere with biosynthesis of the pathogen cell
wall. Ex: Penicillin |
| Therapeutic Actions: 4 | Prevent the cells of the invading organism from
using substances essential to their growth and
development, leading to an inability to divide and
eventual cell death.
Ex: Sulfonamides, Antimycobacterials, &
trimethoprim-sulfamthoxazole. |
| Therapeutic Actions: 5 | Interfere with the steps involved in protein
synthesis, functions to maintain the cell and allow
cell division. Ex: Aminoglycosides, macrolides and
chloramphenicol. |
| Therapeutic Actions: 6 | Interferes with DNA synthesis in the cell, leading to
inability to divide and cell death. Ex: Fluroquinolones |
| Therapeutic Actions: 7 | alters the permeability of the cell membrane to
allow essential cellular components to leak out,
causing cell death.
• ex: antibiotics, antifungals, antiprotozoals |
| Therapeutic actions: 1-7 | congratulations |
| Drug Therapy Across the Lifespan: Anti-Infective Agents: Children:
Use anti infectives with caution; early exposure can lead to?
Controversy is widespread regarding the use of antibiotics to treat 'what?' infections, a common pediatric problem.
Because children can have increased susceptibility to the gastrointestinal (GI) and nervous system effects of anti-infectives, monitor ??? carefully. | early sensitivity;
ear;
hydration and nutritional status |
| Drug Therapy Across the Lifespan: Anti-Infective Agents: Adults:
Adults often demand anti-infectives for a "???" of various signs and symptoms.
??? can be a big problem with this group.
Pregnant and nursing women must exercise extreme caution in the use of anti-infectives. Many of them can ???, leading to toxic effects in the ???. | "quick cure";
Drug allergies and the emergence of resistant strains;
affect the fetus and also cross into breast milk..., leading to toxic effects in the neonate |
| Drug Therapy Across the Lifespan: Anti-Infective Agents: Older Adults:
Older patients often do not present with ??? that are seen in younger people.
??? are important to determine the type and extent of many infections.
The older patient is susceptible to severe:... and must be monitored for?
Anti-infectives that adversely affect the liver (part of the GI) and kidneys must be used with caution in older patients, who may have? | the same signs and symptoms of infection;
Culture and sensitivity;
...severe adverse GI, renal, and neurological effects and must be monitored for nutritional status and hydration during drug therapy.;
decreased organ function |
| varying effectiveness of anti- infective against invading
organisms; range of bacteria against which an antibiotic is effective. | Spectrum |
| so selective in action that they are effective
against only a few microorganism w/ a very specific metabolic
pathway or enzyme. | Narrow spectrum |
| biochemical reactions in many different kinds of
microorganisms, making treatment in wide variety of infections. | Broad spectrum |
| those that causes death of bacteria. (FUNGICIDAL) | Bactericidal |
| prevents replication of bacteria, by interfering w/
proteins or enzyme system necessary for reproduction of bacteria. (FUNGASTATIC) | Bacteriostatic |
| sample of bacteria (e.g. from sputum, cell scrapings, urine) to
be grown in a laboratory to determine the species of bacteria that is causing an infection. | Culture |
| evaluation of bacteria obtained in
a culture to determine what antibiotics the organisms
are sensitive and which agent would be appropriate for
treatment of a particular infection. | Sensitivity testing |
| treatment to prevent an infection before
it occurs. | Prophylaxis |
| ability of the bacteria to adapt to an
antibiotic and produce cells that are no longer affected
by the drug. | Resistance |
| property of antibiotics that allows
them to affect certain proteins or enzyme systems used
by bacteria but not by human cells, sparing human cells. | Selective toxicity |
| Under the umbrella, in relation, or under the scope of Human Immune Response, anti-infective therapy is? | the reduction of the population of the invading organism to a point at which the immune response can take care of the infection. |
| Human Immune Response involves complex interaction among: | chemical mediators, leukocytes, lymphocytes, anti-bodies, locally released enzymes and chemicals. |
| true or false:
Human Immune Response can eliminate all foreign proteins, bacteria, fungi, and viruses. | true |
| Immunocompromised is difficult to treat because: 2 | 2.) these pt. do not have immune response in place to deal with even a few invading organism. |
| Immunocompromised is difficult to treat because: 1 | 1.) anti-infective drugs cannot totally eliminate the pathogen without causing severe toxicity in the host. |
| Immunocompromised is difficult to treat because: 1-2: | 1.) anti-infective drugs cannot totally eliminate the pathogen without causing severe toxicity in the host.
2.) these pt. do not have immune response in place to deal with even a few invading organism. |
| Can be natural or acquired
Refers to the ability over time to adapt to an anti-infective drug
and produce cells that are no longer affected by a particular
drug. | Resistance |
| Resistance:
Many microorganisms do not use the systems
or processes (acting on specific enzyme systems or biological
processes) are not affected by a particular anti-infective drug. An
innate resistance should be anticipated. | Natural or intrinsic |
| Acquiring resistance: 1 | Producing an enzyme that deactivates the antimicrobial drug |
| Acquiring resistance: 2 | Changing cellular permeability to prevent the drug from entering the cell or altering transport systems to exclude the drug from active transport into the cell. |
| Acquiring resistance: 3 | Altering binding sites on the membranes or ribosomes, which then no longer accept the drug. |
| Acquiring resistance: 4 | Producing a chemical that acts as an antagonist to the drug. |
| Acquiring resistance: 1-4 | congratulations |
| Preventing resistance: 1 | Limit the use of the antimicrobial agents to the treatment of specific pathogens known to be sensitive to the drug. |
| Preventing resistance: 2 | Doses should be high enough and the duration to eradicate even slightly resistant microorganism |
| Preventing resistance: 3 | Around-the-clock dosing eliminates the peak and valleys in drug concentration and helps maintain a constant therapeutic level. |
| Preventing resistance: 4 | Drug duration is critical to ensure that the microbes are completely eliminated and not given the chance to grow and develop resistant strains |
| Preventing resistance: 1-4 | Congratulations |
| Patient and Family Teaching: Using Anti-Infective Agents:
This (anti-infective) is prescribed for treating the particular infection that one have now. Do not?
This drug needs to be taken as ???- for the correct number of times each day and for the full number of days. Do not stop taking the drug if you start feeling better. You need to take the drug for the full number of treatment days to ensure that the infection has been destroyed. | use this drug to treat other infections;
prescribed |
| Factors identification of correct pathogen and selection of drug: a: | cause the least complications for that particular patient |
| Factors identification of correct pathogen and selection of drug: b: | Be most effective against the pathogen involved. |
| Identification of the pathogen: | Identification via culture, growing in an agar plate.
Effectivity will be via Sensitivity Testing on the cultured microbes- staining techniques and microscopic examination identify the bacterium
Stool can be examined for ova and parasites. |
| Combination Therapy: May be used for several reasons: 1 | Allow the health care provider to use a smaller dosage of each drug leading to therapeutic effect. |
| Combination Therapy: May be used for several reasons: 2 | Drugs are synergistic, more powerful when given in combination. |
| Combination Therapy: May be used for several reasons: 3 | Many microbial infections are caused by more than organism, and each pathogen may react to a different anti-infective agent. |
| Combination Therapy: May be used for several reasons: 4 | Combined effects of the different drugs delay emergence of resistant strains. |
| Combination Therapy: May be used for several reasons: 1-4 | congratulations |
| Adverse Reactions to Anti-infective therapy: 1:
Occurs most frequently with drugs that are metabolized by this excretory organ and eliminated in urine.
ranging from organ dysfunction to full-blown organ
failure.
Ex: Aminoglycosides; monitored for any signs of
renal dysfunction.
To prevent: well hydration of patient in the course of
treatment. | Kidney damage |
| Adverse Reactions to Anti-infective therapy: 2:
• - toxic effects on the cells lining the GI tract,
causing nausea, vomiting, stomach upset, diarrhea.
• - death of the microorganism releases chemicals
and toxins which can stimulate the chemoreceptor
trigger zone (CTZ) in the medulla and induce
nausea and vomiting.
• - liver toxicity – can cause hepatitis and liver failure
• - Ex: Cephalosporins- monitoring of any signs of
liver dysfunctions and should be stopped at any
sign of liver dysfunction. | GI toxicity |
| Adverse Reactions to Anti-infective therapy: 3:
• - damage or interfere with the function of nerve
tissue.
• - Ex: Aminoglycosides, collect in 8th cranial nerve
causing dizziness, vertigo, and loss of hearing.
• Chloroquine, used to treat malaria and
rheumatoid disorders; accumulate in the retina and
optic nerve causing blindness. | Neurotoxicity |
| Adverse Reactions to Anti-infective therapy: 4
• or allergic reactions
• when protein binding transfer through the
cardiovascular system, able to cause antibody
formation; next exposure to drug, immediate or
delayed allergic responses.
• - complete patient history before administration. | Hypersensitivity Reactions |
| Adverse Reactions to Anti-infective therapy: 5:
• anti- infective causes at times destruction of the
normal flora thus opportunistic pathogens have the
opportunity to invade tissues and cause infections.
• - common superinfections include vaginal or GI
yeast infections, proteus and pseudomonas which
are a result of broad spectrum antibiotic use.
• - pt.’s should be monitored closely and
appropriate treatment should be started as soon as
possible. | Superinfections |
| Adverse Reactions to Anti-infective therapy: 1-5 | kidney,
GI toxicity,
Neurotoxicity,
Hypersensitivty reactions,
superinfections |
| • - to prevent infections before they occur.
• Ex: When patients anticipate travelling to an area
where malaria is endemic, they begin taking
antimalarial drugs. | Prophylaxis |
| • - are chemicals that inhibit specific bacteria.
• -Bacteriostatic
• - Bactericidal
• - Bacteriostatic and Bactericidal
• Use to treat a wide variety of systemic and topical
infections. | Antibiotics |
| • 3 ways antibiotics are made: | • A) living microorganisms
• B) synthetic manufacturer
• C) genetic engineering |
| • Bacteria invade human body through:
RGS | • 1) respiratory
• 2) gastrointestinal (GI)
• 3) Skin |
| • S/S of the body responding to an invader:
FLSCR | • Fever
• Lethargy
• Slow-wave sleep induction
• Classic signs of inflammation
• ( redness, swelling, heat, and pain). |
| • - those whose cell wall retains stain known as Gram’s stain
• - or resist discoloration with alcohol during C/S testing.
• Commonly associated with infection of respiratory tract and
soft tissues. Ex: Streptococcus pneumonia | Gram-positive bacteria |
| • - whose cell walls lose a stain
• - or are decolorized by alcohol.
• associated with infections of G.U. or G.I. tract.
• Ex: Escherichia coli | Gram-negative bacteria |
| - bacteria depend on oxygen for survival. | Aerobic |
| - bacteria do not use oxygen.
• ex: gangrene | Anaerobic |
| Antibiotic selection for use in particular clinical situation if C/S is not possible: 1 | Clinicians attempt to administer drug with broad spectrum of activity against gram positive or gram negative bacteria. |
| Antibiotic selection for use in particular clinical situation if C/S is not possible: 2 | Given at the beginning of treatment until the exact organism and sensitivity can be established. |
| Antibiotic selection for use in particular clinical situation if C/S is not possible: 3 | Clinicians look for selective toxicity
or ability to strike foreign cells with little or no effect on human cells |
| Antibiotic selection for use in particular clinical situation if C/S is not possible: 4 | Antibiotics are given in combination to promote synergistic |
| Antibiotic selection for use in particular clinical situation if C/S is not possible: 5 | Antibiotics are used as prophylaxis |
| Antibiotic selection for use in particular clinical situation if C/S is not possible: 1-5 | congratulations |
| Chain of infection or breaking the chain: 1: | Infectious Agent
Diagnosis/treatment
Bacteria, Fungi,Viruses |
| Chain of infection or breaking the chain: 2: | Reservoir/source
Education/policy, Environmental Sanitation, Disinfection
People, Equipment, Water |
| Chain of infection: 3: | Portal of Exit
Handwashing, Control of Aerosols & Splatter
Aerosols, Splatter |
| Chain of infection: 4: | Mode of Transmission/ Means of Transmission
Isolation, Disinfection, Handwashing
Direct contact, Inhalation, Airborne |
| Chain of infection: 5: | Portal of Entry
First Aid, Personal Hygiene, Handwashing
Mucous membranes, Respiratory Tract, Broken Skin (integrity) |
| Chain of infection: 6: | Susceptible Host
Treatment of underlying Diseases Immunization |
| Chain of infection: 1-6
I
R
P
M
P
S | Infectious Agent
Reservoir
Portal of Exit
Mode of Transmission
Portal of Entry Susceptible Host |
| A group of powerful antibiotics used to treat gram
negative aerobic bacilli. | Aminoglycosides |
| 15mg/kg/d intramuscular (IM) or intravenous (IV) divided into two or three equal doses; reduce dose in renal failure
available IM or IV, use for serious/treatment of gram-negative infections.
potential for nephrotoxicity and ototoxicity, use only as long as necessary. | Amikacin (Amikin) |
| Adult: 3 mg/kg/d IM or IV in three equal doses q8h; reduce dose in renal failure.
Pediatric: 2-2.5 mg/kg/d q8h IV or IM
forms: ophthalmic, topical, IV, intrathecal, impregnated beads on surgical wire and liposomal injection.
Covers wide variety of gram-negative infections, including pseudomonal diseases or pseudomonas and AIDS. | Gentamicin (Garamycin) |
| 7.5 mg/kg q12h IM or 15 mg/kg/d IV divided into two to three equal doses given slowly.
available in parenteral and oral forms, used to treat hepatic coma (and to decrease gastrointestinal (GI) normal flora) when ammonia- producing bacteria in the GI tract cause serious illness.
adjunct therapy to GI bacterial flora.
Should not be used 7 to 10 days due to potential toxic effects
like renal damage, bone marrow depression, and GI
complications. | Kanamycin (Kantrex) |
| Adult: 4-12 g/d in divided doses PO for 5-6 d
Pediatric: 50-100 mg/kg/d in divided doses PO for hepatic coma
a slightly milder aminoglycoside that is used to suppress GI bacteria preoperatively and to treat hepatic coma.
Topical form, used to treat skin wounds and infection. | Neomycin (Mycifraudin) |
| Adult: 1-2 g/d IM in divided doses q6-12h
Pediatric: 20-40 mg/kg/d IM in divided doses q6-q12h
Fourth drug in combination therapy regimen for treatment of tuberculosis; treatment of severe infections if the organism has been shown to be sensitive to streptomycin and no-less-toxic drugs can be used. | streptomycin (generic) |
| Adult: 3 mg/kg/d in three equal doses IM or IV q8h; reduce dose in renal failure; 300 mg b.i.d. by nebulizer.
Pediatric: 300 mg b.i.d. by nebulizer
Short-term IV or IM treatment of serious infections; occular infections caused by susceptible bacteria; nebulizer management of cystic fibrosis and P. (Pseudomonas) aeruginosa infections | tobramycin (TOBI, Tobrex) |
| Aminoglycosides: Therapeutic Actions and Indications: Aminoglycosides are bactericidal. Inhibit protein synthesis in susceptible strain of gram-negative bacteria, which in turn leads to loss of functional integrity of ???, causing cell death. | bacterial cell wall membrane |
| Aminoglycosides: Therapeutic Actions and Indications: Used to treat? | Pseudomonas aeroguinosa, E. coli, Proteus, Klebsiella- Enterobacter-Serratia group, Citrobacter and staphylococcus such as S. Aureus. |
| Aminoglycosides: Therapeutic Actions and Indications: Aminoglycosides are indicated for the treatment of serious infections that are ???. Used before C/S test have been completed. | susceptible to penicillin when penicillin is contraindicated |
| Aminoglycosides: Pharmacokinetics: poorly absorbed from ??? but rapidly absorbed via ???, peak levels within ???. | GI tract;
IM;
1 hour |
| Aminoglycosides: Pharmacokinetics: Widely distributed throughout body, crossing ???.
Use cautiously during pregnancy and lactation potential toxic
effects to ???.
considerably a teratogen | placenta and breast milk;
fetus or neonate |
| Aminoglycosides: Pharmacokinetics: Excreted unchanged in urine; average half-life ???. | 2-3 hours |
| Aminoglycosides: Pharmacokinetics: Urine function should be tested ???. | daily. |
| Aminoglycosides: Contraindications and cautions: C/I: known ??? disease that could exacerbate by toxic aminoglycoside effects and that could interfere with drug metabolism and excretion, leading to higher toxicity. | allergy, renal and hepatic |
| Aminoglycosides: Contraindications and cautions: Pre-existing ??? could be intensified with the effects on auditory nerve. | hearing loss |
| Aminoglycosides: Contraindications and cautions: Worsened on normal defense mechanisms; ??? exacerbation on nervous system. | myasthenia gravis or parkinsonism |
| Aminoglycosides: Contraindications and cautions: ??? causes serious effects on baby, and in pregnancy. | Lactation |
| Aminoglycosides: Adverse effects: confusion, depression, disorientation, dingling, numbness, weakness | CNS effects |
| Aminoglycosides: Adverse effects: CNS effects: leading to irreversible deafness | ototoxicity |
| Aminoglycosides: Adverse effects: CNS effects: resulting from drug effects on auditory nerve | Vestibular paralysis |
| Aminoglycosides: Adverse effects: GI effects:
Results from: | nausea, vomiting, diarrhea, weight loss, stomatitis, hepatic toxicity;
GR irritation, loss of bacteria normal flora with resultant superinfections, and toxic effects in the mucous membranes and liver as drugs are metabolized. |
| Aminoglycosides: Adverse effects: palpitations, hypotension and hypertension | Cardiac effects |
| Aminoglycosides: Adverse effects: purpura, rash, urticaria, and exfolliative dermatitis | Hypersensitivity reactions |
| Aminoglycosides: Drug to drug interactions: If combined with ???, neurotoxicity increases the incidence of ototoxicity, nephrotoxicity, and neurotoxicity. Combination should be avoided if possible. | diuretics |
| Aminoglycosides: Drug to drug interactions: Increases ??? if given with anesthetics, nondepolarizing muscular blockers, succinocholine, or citrate anticoagulated blood. | neuromuscular blockade with paralysis |
| Aminoglycosides: Drug to drug interactions: Have ??? effect when given with penicillin's, cephalosporins, carbenicillin, or
ticarcillin. Used therapeutically on Inc. effectiveness of treatment. | synergistic bactericidal effect |
| Aminoglycosides: Nursing considerations: Assessment: | Hx (history taking) & Examination
screen for: possible C/I or caution for use of drug:
known allergy; Hx of renal and hepatic disease; pre-
existing hearing loss; active infection with herpes,
varicella, fungal or mycobacterial organism,
myasthenia gravis; parkinsonism, infant botulism and
current pregnancy & lactation. |
| Aminoglycosides: Nursing considerations: ??? should be established, baseline data for assessing the effectiveness of the drug and
occurrence of any drug adverse effects associated with drug therapy. | P.E or P.A. (Physical Examination or Physical [attributes?]) |
| Aminoglycosides: Nursing considerations: - C & S test, auditory testing, V/S, RR &
adventitious sounds to monitor ???. | hypersensitivity |
| Aminoglycosides: Nursing considerations: Temperature to ???; Bp to monitor ???. | assess signs of infections; cardiovascular effects of the drugs |
| Aminoglycosides: Nursing considerations: Renal and hepatic function test to determine ???. | baseline function of these organs, and possibility the need to adjust dosage |
| Aminoglycosides: Nursing considerations: NURSNG Dx related to drug therapy: 1 | Acute pain related to G.I. effects of drug. |
| Aminoglycosides: Nursing considerations: NURSNG Dx related to drug therapy: 2 | Disturbed Sensory Perception (auditory) related to
CNS effects of drug. |
| Aminoglycosides: Nursing considerations: NURSNG Dx related to drug therapy: 3 | Risk for infection related to bone marrow suppression. |
| Aminoglycosides: Nursing considerations: NURSNG Dx related to drug therapy: 4 | Excess Fluid Volume related to nephrotoxicity. |
| Aminoglycosides: Nursing considerations: NURSNG Dx related to drug therapy: 5 | Deficient Knowledge regarding drug therapy. |
| Aminoglycosides: Nursing considerations: NURSNG Dx related to drug therapy: | 1. Acute pain related to G.I. effects of drug.
2. Disturbed Sensory Perception (auditory) related to
CNS effects of drug.
3. Risk for infection related to bone marrow suppression.
4. Excess Fluid Volume related to nephrotoxicity.
5. Deficient Knowledge regarding drug therapy. |
| Aminoglycosides: Drug Interactions: | Toxic liver reactions increases
Quinidine, metoprolol, propranolol, corticosteroids,
oral contraceptives, oral anticoagulants, oral anti-
diabetic agents, digoxin, thephylline, methadone,
phenytoin, verapramil, cyclosporin, ketoconazole.
Monitor pt’s. closely and dosage adjustments. |
