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Pharmacology of Antimicrobials
ANTIMICROBIALS--PART I: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Therapeutic Goal: Clear Tissue of Infecting Organisms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Drug by Microorganism Affected ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Antibiotics by Mechanism of Action ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Important Antimicrobial Drug Concepts: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antimicrobial Resistance ,[object Object],[object Object]
Antimicrobial Resistance:   Culture and Sensitivity Testing of Bacteria ,[object Object],[object Object],[object Object],[object Object]
Mechanisms of Antimicrobial Resistance ,[object Object],[object Object],[object Object],[object Object],[object Object]
Factors Promoting Development of Antimicrobial Resistance ,[object Object],[object Object],[object Object]
Common Resistant Microbes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Principles of Antimicrobial Selection and Administration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Principles of Antimicrobial Selection and Administration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Abscess
Principles of Antimicrobial Selection and Administration ,[object Object],[object Object],[object Object]
Principles of Antimicrobial Selection and Administration: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Which of the following promote antimicrobial resistance? ,[object Object],[object Object],[object Object],[object Object]
Patient Variables in Administering Antimicrobials   ,[object Object],[object Object],[object Object],[object Object]
Adverse Effects of Antibiotic Therapy ,[object Object],[object Object],[object Object]
Pseudomembranous colitis
Nursing Implications for Antimicrobial Therapy ,[object Object],[object Object],[object Object],[object Object]
Nursing Implications for Antimicrobial Therapy   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Stevens Johnsons Syndrome ,[object Object]
Nursing Implications: VI. Intravenous Administration of Antibiotics ,[object Object],[object Object],[object Object],[object Object],[object Object]
Antimicrobials: PART II ,[object Object],[object Object],[object Object]
I. Antibiotics Affecting the Bacterial Cell Wall:   Beta-Lactam Antibiotics ,[object Object],[object Object],[object Object],[object Object]
Types of Beta-Lactam Antibiotics: ,[object Object],[object Object],[object Object],[object Object],Lehne, 2007,  Pharmacology for Nursing Care, 6 th  ed., Elsevier, p. 963
1. Penicillins ,[object Object],[object Object],[object Object],[object Object]
Pharmacokinetics of Penicillins ,[object Object],[object Object],[object Object],[object Object],[object Object]
Blood Levels of Different Formulations of Penicillin G Lehne, 2007,  Pharmacology for Nursing Care,  6 th  ed., Elsevier, p. 966
Penicillin Allergy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Adverse Effects & Drug Interactions of Penicillins ,[object Object],[object Object],[object Object]
Beta-Lactamases (Penicillinases) ,[object Object],[object Object],Lehne, 2007,  Pharmacology for Nursing Care, 6 th  ed., Elsevier, p. 964
Beta-Lactamase Inhibitors ,[object Object],[object Object],[object Object]
Penicillin-Beta-Lactamase Inhibitor Combinations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Penicillin works by: ,[object Object],[object Object],[object Object],[object Object]
2. Cephalosporins ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Major Differences between Cephalosporin Generations Lehne, 2007,  Pharmacology for Nursing Care,  6 th  ed., Elsevier, p. 973 Generation Activity against Gram Negative Resistance to Beta-Lactamases Distribution to CSF 1 st  (e.g., cephalothin) Low Low Poor 2 nd  (e.g., cefamandole) Higher Higher Poor 3 rd  (e.g. cefotaxime) Higher Higher Good 4 th  (e.g. cefepime) Highest Highest Good
Possible Problems with Cephalosporins ,[object Object],[object Object],[object Object]
3.  Carbapenems: (imipenem, meropenem & ertapenem) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
II. Non-Beta-Lactam Antibiotic Affecting the Bacterial Cell Wall:   Vancomycin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Adverse Effects of Vancomycin ,[object Object],[object Object],[object Object],[object Object]
III. Bacteriostatic Inhibitors of Protein Synthesis: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Porth,  Pathophysi-ology, Concepts of Altered Health States, 7 th  ed.,  2005, Lippincott, p. 123. Protein Synthesis
1.Tetracyclines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Problems with Tetracyclines ,[object Object],[object Object],[object Object]
Tetracycline-Stained Teeth http://www.wisconsinreconstructiveimplantdentist.com/images/tetracycline4.jpg The patient was treated with tetracycline while the permanent teeth were developing. Dark staining is present in the parts of the teeth that were forming during treatment.
2. Macrolides: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
2. Macrolides ,[object Object],[object Object],[object Object]
WARNING! ,[object Object]
3 .  Clindamycin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IV. Bacteriocidal Antibiotics that Alter Protein Synthesis:  Aminoglycosides ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Aminoglycoside Administration ,[object Object],[object Object]
Aminoglycoside: Gentamicin Levels Lehne, RA,  Pharmacology for Nursing Care, 5 th  ed.,  2004, Saunders, p. 922
V. Sulfamethoxazole-trimethroprim (Bactrim) ,[object Object],[object Object],[object Object],[object Object],Lehne, RA,  Pharmacology for Nursing Care, 5 th  ed.,  2004, Saunders, p. 927
Sulfamethoxazole-trimethroprim (Bactrim) ,[object Object],[object Object],[object Object],[object Object],[object Object]
VI. Fluoroquinones ,[object Object],[object Object],[object Object],[object Object],[object Object]
Adverse Effects of Fluoroquinones ,[object Object],[object Object],[object Object],[object Object],[object Object]
Vyas H and Krishnaswamy G. N Engl J Med 2007;357:2067 An 81-year-old woman with rheumatoid arthritis, Sjogren's syndrome, and hypertension presented with swelling and pain in the area of the left heel, which had developed suddenly a week after a short course of levofloxacin for acute bronchitis
VII. Metronidazole (Flagyl) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VIII. Antibiotics for Tuberculosis Target  Mycobacteria ,[object Object],[object Object],[object Object],[object Object]
Mycobacteria infection ,[object Object],[object Object],[object Object],[object Object]
VIII. Tuberculosis Drug:  Isoniazid ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VIII. Tuberculosis Drug:  Rifampin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VIII. Tuberculosis Drug: Pyrazinamide ,[object Object],[object Object]
VIII. Tuberculosis Drug:  Ethambutol ,[object Object],[object Object],[object Object],[object Object]
Antifungals: Amphotericin B ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antifungals: Ketoconazole ,[object Object],[object Object],[object Object],[object Object],[object Object]
Antivirals: Acyclovir ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Herpes Zoster (Shingles) http://www.healthline.com/channel/herpes-zoster_images?id=1507
Antivirals: Ganciclovir ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antivirals: Drugs for Influenza ,[object Object],[object Object],[object Object],[object Object]
Drugs for Influenza ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Amphotericin B is an: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Human Immunodeficiency Virus Photo: Hardin MD/University of Iowa and CDC  http://www.lib.uiowa.edu/HARDIN/MD/cdc/948.html
Warning! ,[object Object],[object Object],[object Object]
Of particular note! ,[object Object],[object Object],[object Object]
HIV drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HIV Meds (cont’d) ,[object Object],[object Object],[object Object],[object Object]
HIV Drugs Lehne, 2007,  Pharmacology for Nursing Care, 6 th  ed., Elsevier, p. 1067
Pregnant HIV-Infected Patients ,[object Object],[object Object],[object Object],[object Object]
I. & II. Reverse Transcriptase Inhibitors ,[object Object],[object Object],[object Object],NRTIs NNRTIs
I. Nucleoside Reverse Transcriptase Inhibitors (NRTIs) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Facial Lipoatrophy http://img.thebody.com/legacyAssets/09/64/ellen.jpg
II. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
III. Protease Inhibitors (PIs) ,[object Object],[object Object],Lehne, 2007,  Pharmacology for Nursing Care, 6 th  ed., Elsevier, p. 1067 PIs
III. Protease Inhibitors (PIs) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Buffalo Hump http://www.righthealth.com/topic/Buffalo%20Hump?as=clink&ac=1437&afc=2168586466&p=
Enlarged Abdomen .
III. Protease Inhibitors ,[object Object],[object Object],[object Object]
IV. Entry Inhibitors ,[object Object],[object Object],[object Object],[object Object],Lehne, RA,  Pharmacology for Nursing Care, 5 th  ed.,  2004, Saunders, p. 986 Fusion  Inhibitor Attachment  Inhibitor
Fusion Inhibitor (Enfuvirtide (Fuzeon) ,[object Object],[object Object]
Fusion Inhibitor:   Enfuvirtide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Attachment Inhibitors ,[object Object],[object Object],[object Object],[object Object]
IV. Attachment Inhibitors: Maraviroc ,[object Object],[object Object],[object Object],[object Object],[object Object]
V. Integrase Inhibitors   ,[object Object],[object Object],[object Object],[object Object],Lehne, RA,  Pharmacology for Nursing Care, 5 th  ed.,  2004, Saunders, p. 986 Integrase  Inhibitor
V. Integrase Inhibitors: Raltegravir ,[object Object],[object Object],[object Object],[object Object],[object Object]
All of the following are classes of HIV medications  EXCEPT: ,[object Object],[object Object],[object Object],[object Object]
Resistance and Adherence ,[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusion ,[object Object],[object Object],[object Object]
Anti infectives fall 2011

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Anti infectives fall 2011

Notes de l'éditeur

  1. An 81-year-old woman with rheumatoid arthritis, Sjogren's syndrome, and hypertension presented with swelling and pain in the area of the left heel, which had developed suddenly a week after a short course of levofloxacin for acute bronchitis. She reported neither trauma to the area nor any excessive physical activity before the pain began. Examination revealed an ecchymotic area around the left posterior heel and a moderately swollen calf. A defect was palpable in the lateral side of the Achilles' tendon; the medial side was still intact. Movement of the ankle was limited by severe pain. Magnetic resonance imaging (MRI) of the ankle revealed a near-full-thickness rupture of the Achilles' tendon (Panel A, arrows). The patient's ankle was immobilized in a short leg cast for 2 months. After removal of the cast, a repeat MRI scan showed nearly complete healing of the ruptured tendon (Panel B, arrows), and since then, the patient has been walking without limitation. Quinolones may facilitate the enhanced expression of matrix metalloproteinases in tissue, which in turn causes tendon injury and is most common in the elderly and in persons taking corticosteroids.