Transcript Pharmacology and Pathophysiology II

Pharmacology and
Pathophysiology II
Anti - Infectives
Erythromycin is in which classification?
Macrolides
Penicillin
Third Generation Cephalosporin
Lincosamide
This medication could cause thrombocytopenia
Vancomycin
Bactrim
Zyvox
Rocephin
This medication should not be used in a patient taking
Cimetidine for GERD
Avelox
Cipro
Bacitracin
Tetracycline
A patient states she is allergic to keflex. Which medication
order would you question?
PenVK
Bactrim
Gentamicin
Vancomycin
This medication causes red man syndrome at toxic levels
Azithromycin
Zyvox
Cipro
Vancomycin
This is a gram positive cocci
H. Pylori
MRSA
Proteus
Strep Pneumoniae
Which of the following is true about prostaglandins?
They intensify histamine and kinin effects
Produced by mast cells
Are responsible for phagocytosis
Create antibodies
Which of the following is not part of the RNA – DNA
replication process?
Transcription
Translation
Transmission
Replication
Tetracyclines
• Natural and semisynthetic compounds
• Inhibit bacterial protein synthesis
Sulfonamides
• Bacteriostatic
• Gram Positive and Gram Negative
– E. Coli
– Staph. Aureus
– Klebsiella
– Enterobacter
• Ulcerative Colitis
– Inhibits inflammation when sulfasalazine interacts
with intestinal bacteria
Sulfonamides
• Uses
– UTI
– Acute Otitis Media
– Treatment and Prevention of Infection for 2nd and
3rd Degree Burns
• Sulfamylon
• Silvadene
Penicillins
• Uses
– UTI
– Septicemia
– Meningitis
– Intra-Abdominal Infections
– STDs
• Syphilis
– PNA and other respiratory infections
Tetracyclines
• Uses
– Rickettsial Diseases
• Rocky Mountain Spotted Fever, Typhus fever
– Skin and Soft Tissue Infections
– Uncomplicated urethral, endocervical or rectal
infections
– H. pylori
• Treated in combination with metronidazole and
bismuth subsalicylate
Penicillins
• Uses
– UTI
– Septicemia
– Meningitis
– Intra-Abdominal Infections
– STDs
• Syphilis
– PNA and other respiratory infections
Tetracyclines
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Remember: CYCLINE
Doxycycline (Vibramycin)
Tetracycline (Sumycin)
Tigecycline (Tygacil)
Tetracyclines
• Adverse Reactions
– N/V/D
– Epigastric Distress
– Somatitis
– Sore Throat
– Sin Rash
Tetracyclines
• Contraindications
– Pregnancy
– Lactation
– Children under 9
• Permanent discoloration of teeth
– Impaired renal function
Tetracyclines
• Interactions
– Antacids with aluminum, zinc, magnesium or
bismuth salts
• Decreased tetracycline effectiveness
– Anticoagulants
• Increased bleeding risk
– Contraceptives (oral)
• Decreased contraceptive effectiveness
– Digoxin
• Increased digitalis toxicity
Aminoglycosides
• Block Protein synthesis
• Disrupt functional ability of bacterial cell wall
Aminoglycosides
• Uses
– Hepatic Coma (encephalopathy)
• Reduces ammonia forming bacteria in intestinal tract
– Prior to surgery
• Reduction in flora
Aminoglycosides
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Remember: CIN*
Amikacin (Amikin)
Gentamicin
Neomycin
Streptomycin
• * - can be confused with macrolides and
lincosamides
Aminoglycosides
• Adverse Reactions
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N/V/D
Anorexia
Rash
Urticaria
Ototoxicity
• Tinitis
• Vertigo
• Hearing loss
– Neurotoxicity
• Numbness
• Circumoral or peripheral paresthesia
– Nephrotoxicity
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Proteinuria
Hematuria
Increased BUN and Creatinine
Decreased Urinary Output
Aminoglycosides
• Contraindications
– Myasthenia Gravis
– Parkinsonism
– Preganancy
– Lactation
Aminoglycosides
• Interactions
– Cephalosporin
• Increased risk of nephrotoxicity
– Loop Diuretics
• Increased risk of ototoxicity
– Pavulon and Anectine (anesthesia)
• Increased risk of neuromuscular blockade
Macrolides
• Bacteriostatic or bactericidal
• Causes changes in protein function and
synthesis
Macrolides
• Uses
– Gram Negative and Gram Positive
– Acne Vulgaris
– Skin Infections
– Upper Respiratory Infections caused by
Hemophilus influenzae (Hib)
• In conjunction with sulfonamides
Macrolides
• Adverse Reactions
– N/V/D
– Abdominal Pain and Cramping
Macrolides
• Contraindications
– Preexisting liver disease
– Myasthenia Gravis
– Pregnancy
Macrolides
• Interactions
– Antacids with aluminum salts, kaolin or magaldrate
• Decreased absorption and effectiveness of macrolides
– Digoxin
• Increased dig levels
– Anticoagulants
• Increased bleeding risk
– Clindamycin, lincomycin or chloramphicol
• Decreased therapeutic level of macrolides
– Theophylline
• Increased Theophylline Level
Lincosamides
• Inhibit Protein Synthesis
– Causes cell death
• High potential for toxicity
• Used when PCN or Erythromycin are
ineffective
Lincosamides
• Clindamycin (Cleocin)
• Lincomycin (Lincocin)
Lincosamides
• Uses
– Gram Negative and Positive Microorganisms
– More serious infections
– May be used with other antibiotics
Lincosamides
• Adverse Reactions
– Abdominal Pain
– Esophagitis
– N/V/D
– Blood dyscrasias
– Pseudomembranous colitis
Lincosamides
• Contraindications
– If taking cisapride
– If taking pimozide
– Minor bacterial or viral infections
Lincosamides
• Precautions
– GI Disorders
– Renal Disease
– Liver Impairment
– Myasthenia Gravis
• Neuromuscular blocking action of lincosamides
Lincosamides
• Interactions
– Kaolin and aluminum based antacids
– Neuromuscular blocking agents (anestesia)
Fluoroquinolones
• Bactericidal
• Interferes with DNA synthesis
Fluoroquinolones
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Ciprofloxacin (Cipro)
Gatifloxacin (Tequin)
Lomefloxacin (Floxin)
Moxifloxacin (Avelox)
Fluoroquinolones
• Uses
– Lower Respiratory Infections
– Bone and Joint Infections
– UTI
– Skin Infections
– STI
– Eye Infections
Fluoroquinolones
• Adverse Reactions
– N/D
– HA
– Abdominal Pain
– Photosensitivity
• More serious adverse reaction
Fluoroquinolones
• Contraindications and Precautions
– Pregnancy
– Younger than 18
– Those unable to adhere to photosensitivity
precautions
– DM
– Renal Impairment
– Hx. Of Seizures
– Geriatrics
– Dialysis
Fluoroquinolones
• Interactions
– Theophylline
• Increased serum level of theophylline
– Cimetidine
• Interferes with elimination of antibiotic
– Oral Anticoagulants
• Increased Bleeding
– Antacids, Iron salts or zinc
• Decreased absorption of Fluoroquinolones
– NSAIDS
• Risk of seizure activity
Other Medications
• Daptomycin (Cubicin)
• Linezolid (Zyvox)
– RNA / DNA Synthesis Inhibitors
Zyvox
• Classification
– Oxazolidinones
• First drug of the new classification
– Binds to a site on a particular ribosomal RNA
– Prevents formation of replication components
• Bacteriostatic
– Enterococci and Staphylococci
• Bactericidal
– streptococci
Zyvox
• Uses
– Vancomycin – Resistant Enterococcus facium
(VREF)
– Pneumonia
– Skin Infections
– Including MRSA
Daptomycin
• Classification
– Cyclic Lipopeptides
• New category of medications
– Binds to cell membrane
• Depolarizes the wall
• Inhibits protein DNA and RNA synthesis
– Bactericidal
Daptomycin
• Uses
– Skin infections
– S. aureus infection of blood
RNA / DNA Synthesis Inhibitors
• Adverse Reactions
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N/V/D
HA
Dizziness
Insomnia
Rash
Fatigue
Depression
Nervousness
Photosensitivity
Pseudomembranous Colitis (Zyvox)
Thrombocytopenia (Zyvox)
RNA / DNA Synthesis Inhibitors
• Contraindications and Precautions
– Zyvox contraindications
• Pregnant
• Lactating
• Phenylketonuria
– Zyvox precautions
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Bone marrow depression
Gepatic dysfunction
Renal impairment
HTN
Hyperthroidism
– Daptomycin contraindications
• Pregnant
• Lactating
RNA / DNA Synthesis Inhibitors
• Interactions
– Zyvox
• NSAIDS
• MAOI
– Decreased effectiveness of Zyvox
• Large amounts of tyramine
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Aged cheese
Caffeinated beverages
Yogurt
Chocolate
Red wine
Beer
Pepperoni
» Risk of severe HTN
RNA / DNA Synthesis Inhibitors
• Interactions
– Daptomycin
• Statins
– Myopathy with elevated CPK levels
Cell Wall Synthesis Inhibitors
• Carbepenems
• Vancomycin
– Gram Positive bacteria
• Aztreonam
– Beta lactam nucleus
• Called a monobactam
RNA / DNA Synthesis Inhibitors
• Uses
– Meropenem
• Intra-abdominal infections
• Bacterial Meningitis
– Primaxin
• Serious Infections
• Endocarditis
• Septicemia
RNA / DNA Synthesis Inhibitors
• Uses
– Doripenem
• Intra-abominal infections
• Complicated UTI
– Vancomycin
• Serious gram Positive infections
• Anti-infective associated pseudomembranous colitis
caused by clostridium difficile
– Monobactams
• Gram Negative Organisms
RNA / DNA Synthesis Inhibitors
• Adverse Reactions
– N/V/D
– Rash
– Carbapenems
• Abscess or phlebitis at injection site
– Vancomycin
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Nephrotoxicity
Chills, fever
Uticaria
Sudden hypotension
Antitubercular Medications
Which of the following is the equivalent to
ampicillin and sulbactam?
Unasyn
Augmentin
Zosyn
Timentin
Which of the following classifications acts on the
30S Chromosomal Subunit?
Penicillin
Tetracycline
Polymixins
Macrolides
Cipro falls into which classification?
Macrolides
Carbapenem
Beta Lactam
Fluoroquinolone
A nurse would be concerned with which medication ordered by a
physician pre-operatively for a patient undergoing general
anesthesia?
Doxycycline
Penicillin
Cipro
TMP - SMZ
A patient has been prescribed PenVK (penicillin with potassium) for a
dental abscess. Which of the following is an appropriate statement
made by the nurse?
PCN acts on 50S Subunit
Notify your physician if you have Myastenthia
Gravis, as PCN is contraindicated
You will need to take additional
precautions if you are on birth control
This medication also works for curing
peptic ulcers
This medication acts on Protein Synthesis
Bactrim
Cipro
Penicillin
Clindamycin
Which patient would you most question the order
for tetracycline 250 mg PO QID?
50 Year Old Male with a peptic ulcer
8 Year Old Male with a skin infection
32 Year Old Female with Chlamydia
trachomatis
60 Year Old Female taking Lovenox 60mg
SQ Daily