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level: Level 1 of Part 2 of Anti-Infective Agents

Questions and Answers List

level questions: Level 1 of Part 2 of Anti-Infective Agents

QuestionAnswer
Nursing Considerations for Pateints Receiving Carbapenems: Assessment: History and Examination: 2: Perform physical assessment to:establish baseline data for assessing the effectiveness of the drug and the occurrence of any adver
New class of broad-spectrum antibiotics effective against gram + and Gram – bacteria. are bactericidal Inhibit cell membrane synthesis in susceptible bacteria.Carbapenems
Carbapenems: Usual Indications: 500 mg intravenous (IV), over 1 h every 8 h for 5-14 d Dosage/Route: Treatment of complicated intra-abdominal infections or clomplicated UTIs, including pyelonephritis, caused by susceptible bacteria.Doripenem (Doribax
Carbapenem: Doripenem (Doribax): Usual Indications:500 mg intravenous (IV), over 1 h every 8 h for 5-14 d
Carbapenem: Doripenem (Doribax): Dosage/ Route:Treatment of complicated intra-abdominal infections or clomplicated UTIs, including pyelonephritis, caused by susceptible bacteria.
Carbapenem: Doripenem (Doribax): Usual Indications: Dosage/Route:500 mg intravenous (IV), over 1 h every 8 h for 5-14 d Treatment of complicated intra-abdominal infections or clomplicated UTIs, including pyelonephritis, caused by susceptible bacteria.
Carbapenems: Usual Indications: 1 g/d IV or intramuscular (IM) for 5-14 d Dosage/Route: Treatment of community-acquired pneumonia, complicated genitourinary infections, acute pelvic infections, complicated intra-abdominal infections, skin and skin-structure infections.Ertapenem (Invanz)
Carbapenems: Ertapenem (Invanz): Usual Indications:1 g/d IV or intramuscular (IM) for 5-14 d
Carbapenems: Ertapenem (Invanz): Dosage/Route:Treatment of community-acquired pneumonia, complicated genitourinary infections, acute pelvic infections, complicated intra-abdominal infections, skin and skin-structure infections.
Carbapenems: Ertapenem (Invanz): Usual Indications: Dosage/Route:1 g/d IV or intramuscular (IM) for 5-14 d Treatment of community-acquired pneumonia, complicated genitourinary infections, acute pelvic infections, complicated intra-abdominal infections, skin and skin-structure infections.
Carbapenems: Usual Indications: 250-500 mg IV q6-8 h or 500-750 mg IM q12h Usual Indication: Pediatric: <1 wk: 25 mg 25mg/kg q12h IV 1-4 wk: 25 mg/kg q8h IV 4 wk-3 mo: 25 mg/kg q6h IV > or = 3 mo: 15-25 mg/kg q6h IV Dosage/Route: Treatment of serious respiratory, intra-abdominal, urinary tract, gynecological, bone and joint, skin and skin-structure infections: septicemia, endocarditis, bone and joint infections, and polymicrobic infectionsImipenem-cilastatin (Primaxin)
Carbapenem: Imipenem-cilastatin (Primaxin): Usual Indications (non-pediatric or adult):250-500 mg IV q6-8 h or 500-750 mg IM q12h
Carbapenem: Imipenem-cilastatin (Primaxin): Pediatric: <1 wk:<1 wk: 25 mg 25mg/kg q12h IV
Carbapenem: Imipenem-cilastatin (Primaxin): Pediatric: 1-4 wk:1-4 wk: 25 mg/kg q8h IV
Carbapenem: Imipenem-cilastatin (Primaxin): pediatric: 4 wk-3 mos:4 wk-3 mo: 25 mg/kg q6h IV
Carbapenem: Imipenem-cilastatin (Primaxin): Pediatric: > or = 3 mos:> or = 3 mo: 15-25 mg/kg q6h IV
Carbapenem: Imipenem-cilastatin (Primaxin): Dosage or Route:Dosage/Route: Treatment of serious respiratory, intra-abdominal, urinary tract, gynecological, bone and joint, skin and skin-structure infections: septicemia, endocarditis, bone and joint infections, and polymicrobic infections
Carbapenems: Usual Indications: Adult: 500- 1000 mg IV q8h Usual Indications: pediatric: 500 mg-2 q IV q8h, depending on infection being treated. Dosage/Route: Treatment of bacterial meningitis, complicated skin and skin-structure infections, intra-abdominal infectionsMeropenem (Merrem IV)
Carbapenems: meropenem (Merrem IV): Usual Indications: Adult:500- 1000 mg IV q8h
Carbapenems: meropenem (Merrem IV): Usual Indications: Pediatric:pediatric: 500 mg-2 q IV q8h, depending on infection being treated.
Carbapenems: meropenem (Merrem IV): Dosage/RouteDosage/Route: Treatment of bacterial meningitis, complicated skin and skin-structure infections, intra-abdominal infections
Carbapenems: meropenem (Merrem IV): Usual Indications: Adult: and; Pediatric: Dosage/RouteUsual Indications: Adult: 500- 1000 mg IV q8h Usual Indications: pediatric: 500 mg-2 q IV q8h, depending on infection being treated. Dosage/Route: Treatment of bacterial meningitis, complicated skin and skin-structure infections, intra-abdominal infections
Carbapenems serious infections caused by susceptible bacteris, leading to cell death: 11 & etc S. P H. I M. C S . A S. P E. C P K. P C. C El BfStreptococcus Pneumoniae (or S. Pneumonia or Pneumonia) Haemophilus influenzae (or H. Influenza or Influenza) Moraxella Catarrhalis (or M. Catarrhalis or M. Catarhalis [sa ppt]) Staphylococcus Aureus (or S. Aureus) Streptococcus Pyrogenes ( or S. Pyrogenes) Escherichia Coli ( or E. coli) Peptostrptococcus Klebisella Pneumoniae (or K. Pneumoniae) Clostridium clostridioforme ( or C. clostridioform) Eubacterium lentum Bacteroides fragilis; and etc.
Carbapenems are indicated for treating serious:intraabdominal, urinary tract, skin and skin structure, bone and joint, and gynecological infections
Carbapenems are rapidly absorbed if given what route?; and reach peak levels at the end of ??? if given IV.Rapidly absorbed IM and reach peak levels at the end of infusion if given IV.
true or false: Carbapenems are Widely distributed throughout the body, and known to cross placenta and breast milk.False, Carbapenems are widely distributed throughout the body, 'not known if they cross placenta and breast milk.'
Carbapenems are excreted ??? in urine; and half-life is?unchanged; 1-4 hours.
Newer class of Carbapenems. Given IV every 8 hrs. by 1hr. infusion for 5-14 days.Doripenem
Can be given IM or IV. Given onc a day for 5-14 days. Depending on infection.Ertapenem
combination of imipenem, w/c interferes with cell wall synthesis and causes bacterial cell death. Cilastatin, inactivates the imipenem and leads to increased urinary excretion of the drug and decreased renal toxicity. Can be given IM or IV. Approved for use in children.Imipenem-cilastatin
1st drug of Carbapenem class, given IV over 1 hr. q8hrs; 5-14 daysMeropenem
Carbapenems Contraindications and cautions: C/I in some conditions: aknown allergy in to any carbanems or beta- lactams
Carbapenems Contraindications and cautions: C/I in some conditions: bseizure disorders- w/c could be exacerbated by the drug
Carbapenems Contraindications and cautions: C/I in some conditions:meningitis- safety of pt’s. with meningitis has not been established.
Carbapenems Contraindications and cautions: C/I in some conditions:Lactation- not known whether this drugs enter breast milk, potentially could cause serious effects on infants.
Carbapenems Contraindications and cautions: C/I in some conditions:a b c d
Carbapenems Contraindications and cautions: Use caution during pregnancy- because?carbapenems used to treat only severe infections. Drug must be carefully weighed against potential adverse effect on fetus.
Carbapenems Contraindications and cautions: Test urine function regularly, because?they depend on the kidney for excretion and are toxic to kidneys.
Carbapenems Contraindications and cautions: is not recommended for use in patients younger than 18 yrs. old.Ertapenem
Carbapenems Contraindications and cautions: is associated w/ development of pseudomembranous colitis and used w/ caution in pt’s. w/ inflammatory bowel disorders.Meropenem
Carbapenems: Adverse effects: atoxic effects on GI tract
Carbapenems: Adverse effects: bpseudomembranous colitis
Carbapenems: Adverse effects: cclostridium difficile diarrhea
Carbapenems: Adverse effects: d: can lead to serious dehydration & electrolyte imbalanceNausea and vomiting
Carbapenems: Adverse effects: e:Monitor pts. to deal w/new infection before it becomes overwhelming.
Carbapenems: Adverse effects: f: Include: When combined with other drugs:CNS effects- Include: headache, dizziness, altered mental state. -seizures- when combined with other drugs.
Carbapenems: Adverse effects:a b c d e f
Indications: Treatment of community-acquired pneumonia, complicated genitourinary infections, complicated intra-abdominal infections, skin and skin-structure infections, and acute pelvic infections caused by susceptible bacteria. Actions: Inhibits protein synthesis in susceptible strains of gram-negative bacteria, disrupting functional integrity of the cell membrane and causing cell death. Pharmacokinetics: Route- IM, IV Onset- Rapid Peak- 30-120 min Half-life: 4 hours; excreted unchanged in the urine. Adverse effects: Headache, dizziness, nausea, vomiting, pseudomembranous clolitis, rash, pain at injection site.Ertapenem
Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: 1Assess for possible contraindications or cautions: known allergy to any carbapenem or beta-lactam (obtain specific information about the nature and occurrence of allergic reactions), history of renal disease, history of seizures and current pregnancy or lactation status, and inflammatory bowel disorders.
Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: 2: Perform physical assessment to:establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy.
Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: Perform culture and sensitivity test at the site of infection to:ensure appropriate use of the drug.
Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: Conduct orientation and reflex assessment to:evaluate any central nervous system (CNS) effects of the drug.
Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: Assess vital signs to:Respiratory rate and adventitious sounds to monitor for signs of infection or hypertension reactions; temperature to assess for signs and symptoms of infection.
Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: Perform renal function tests to determine:baseline function of the kidneys and, possibly, the need to adjust dose.
Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: 1-6congratulations
Nursing diagnoses related to Carbapenems drug therapy might include the following: 1-3Acute pain related to gastrointestinal (GI) or CNS effects of the drug. Risk for infection related to loss of normal flora Deficient knowledge regarding drug therapy
Carbapenems: Implementation With Rationale: 1: Check culture and sensitivity reports to ensure that:this is the drug of choice for this patient.
Carbapenems: Implementation With Rationale: 2: Ensure that the patient receives the full course of the carbapenem as prescribed to:increase effectiveness and decrease the risk for the development of resistant strains of bacteria.
Carbapenems: Implementation With Rationale: 3: Monitor the site of infection and presenting signs and symptoms (e.g., fever, lethargy) throughout the course of drug therapy. Failure of these signs and symptoms to resolve may indicate the need to: Arrange to continue drug therapy for at least 2 days after all signs and symptoms resolve to:reculture the site; decrease the development of resistant strains of bacteria
Carbapenems: Implementation With Rationale: 4: Monitor the patient regularly for signs of:pseudomembranous colitis, severe diarrhea, or superinfections to effectively arrange for discontinuation of drug or decreased dose, as appropriate, if any of these toxicities occurs.
Carbapenems: Implementation With Rationale: 5: Provide safety measure to:protect the patient if CNS effects, such as confusion, dizziness, or seizures, occur.
Carbapenems: Implementation With Rationale: 6: Provide small, frequent meals as tolerated to: Also provide:relieve GI discomfort; also provide adequate fluids to replace fluid lost with diarrhea, if appropriate.
Carbapenems: Implementation With Rationale: 7: Ensure that patient is hydrated at all times during drug therapy to:minimize renal toxicity from drug exposure.
Carbapenems: Implementation With Rationale: 8: Instruct the patient about the appropriate dosage regimen and possible adverse effects to:enhance patient knowledge about drug therapy and to promote compliance.
Carbapenems: Implementation With Rationale: 9: Provide the following patient teaching: 1:Take safety precautions, such as changing position slowly and avoiding driving and hazardous tasks, if CNS effects occur.
Carbapenems: Implementation With Rationale: 9: Provide the following patient teaching: 2:Try to drink a lot of fluids and to maintain nutrition (very important) even though nausea, vomiting, and diarrhea may occur.
Carbapenems: Implementation With Rationale: 9: Provide the following patient teaching: 3:Report difficulty breathing, severe headache, severe diarrhea, fever, and signs of infection.
Carbapenems: Implementation With Rationale: 1-9congratulations
Carbapenems: Evaluation: 1: Monitor patient response to thedrug (resolution of bacterial infection).
Carbapenems: Evaluation: 2: monitor for adverse effects:(orientation and affect, superinfections, GI toxicity, severe diarrhea effects).
Carbapenems: Evaluation: 3:Evaluate effectiveness of the teaching plan (patient can:name drug, dosage, possible adverse effects to watch for, and specific measures to help avoid adverse effects.)
Carbapenems: Evaluation: 4: Monitor effectiveness of:comfort and safety measures and compliance with the therapeutic regimen.
Carbapenems: Evaluation: 1-4congratulations
Introduced since 1960’s ; similar to Penicillin in structure. Based on their gram (-) spectrum & stability in the presence of beta-lactamases. 4 generations, each group with its own spectrum:Cephalosporins
When was Cephalosporins introduced?1960's
4 generations of Cephalosporins: largely effective with gram-positive bacteria that are affected by Penicillin G, as well as Gram negative bacteria, Proteus mirabilis, E. coli, & klebsiella pneumoniae. (PEcK)- bacterias that are susceptible to this generation of Cephalosporin1st generation
4 generations of Cephalosporins: are effective against those strains, also Haemophilus influenzae, Enterobacter aerogenes, & Neisseria species. (HENPeCK). are less effective against gram-positive bacteria.2nd generation
4 generations of Cephalosporins: are weak against gram(+) bacteria but are more potent against gram (--) bacilli as well as against Serratia marcescens (HENPeCKS).3rd generation
4 generations of Cephalosporins: are in development. have improved gram- positive spectrum and expanded gram-negative activity or 3rd generation cephalosporins. Have a greater resistance to beta-lactamases than the third generation cephalosporins. Can cross blood brain barrier and are effective in meningitis. Activity against nosocomial pathogens such as Enterobacter and Acinetobacte.4th generation
active against gram (-) and gram (+) organisms including cephalosporin-resistant staphylococci and P. aerogunosa.Cefepime (Maxipime)
Cephalosporins: 4th generation drugs: (new I think?):Cefepime, Cefluprenam, Cefozopran, Cefpirome, Cefquinome
4th generation Cephalosporin drugs: is more active against pneumococciCefpirome
First-Generation Cephalosporins: Dosage/Route: Adult: 1-2 g PO in a single or two divided doses; reduce dose in renal impariment Pediatric: 30 mg/kg/d PO in divided doses q12h usual indications: Treatment of UTIs, pharyngitis, and tonsilitis caused by group A beta-hemolytic stretptococci, as well as skin infections.Cefadroxil (generic)
First-Generation Cephalosporins: Cefadroxil (generic) Dosage/Route: Adult:Dosage/Route: Adult: 1-2 g PO in a single or two divided doses; reduce dose in renal impariment
First-Generation Cephalosporins: Cefadroxil (generic) Dosage/Route: Pediatric:Pediatric: 30 mg/kg/d PO in divided doses q12h
First-Generation Cephalosporins: Cefadroxil (generic) Dosage/Route: Adult: Pediatric:Dosage/Route: Adult: 1-2 g PO in a single or two divided doses; reduce dose in renal impariment Pediatric: 30 mg/kg/d PO in divided doses q12h
First-Generation Cephalosporins: Cefadroxil (generic): Usual Indications:usual indications: Treatment of UTIs, pharyngitis, and tonsilitis caused by group A beta-hemolytic stretptococci, as well as skin infections.
First-Generation Cephalosporins: Dosage/Route: Adult: 250-500 mg intramuscular (IM) or intravenous (IV) q4-8h; reduce dose in renal impairment. Pediatric: 25-50 mg/kg/d IM or IV in three or four divided doses Usual Indications: Treatment of respiratory tract, skin, genitourinary (GU), biliary tract, bone, joint, and myocardial infections, as well as sepsis.Cefazolin (Zolicef)
First-Generation Cephalosporins: Cefazolin (Zolicef): Dosage/Route: Adult:Dosage/Route: Adult: 250-500 mg intramuscular (IM) or intravenous (IV) q4-8h; reduce dose in renal impairment.
First-Generation Cephalosporins: Cefazolin (Zolicef): Dosage/Route: PediatricPediatric: 25-50 mg/kg/d IM or IV in three or four divided doses
First-Generation Cephalosporins: Cefazolin (Zolicef): Dosage/Route: Adult: Pediatric:Dosage/Route: Adult: 250-500 mg intramuscular (IM) or intravenous (IV) q4-8h; reduce dose in renal impairment. Pediatric: 25-50 mg/kg/d IM or IV in three or four divided doses
First-Generation Cephalosporins: Cefazolin (Zolicef): Usual Indications:Usual Indications: Treatment of respiratory tract, skin, genitourinary (GU), biliary tract, bone, joint, and myocardial infections, as well as sepsis.
First-Generation Cephalosporins: Dosage/Route: Adult: 250 mg PO q6h Pediatric: 25-50 mg/kg/d PO in divided doses Usual indications: Treatment of respiratory, skin, bone, and GU infections; used for otitis media in childrenCephalexin (Keflex)
First-Generation Cephalosporins: Cephalexin (Keflex): Dosage/Route: Adult:Dosage/Route: Adult: 250 mg PO q6h
First-Generation Cephalosporins: Cephalexin (Keflex): Dosge/Route: Pediatric:Pediatric: 25-50 mg/kg/d PO in divided doses
First-Generation Cephalosporins: Cephalexin (Keflex): Dosage/Route: Adult: Pediatric:Dosage/Route: Adult: 250 mg PO q6h Pediatric: 25-50 mg/kg/d PO in divided doses
First-Generation Cephalosporins: Cephalexin (Keflex): Usual indications:Usual indications: Treatment of respiratory, skin, bone, and GU infections; used for otitis media in children
First-Generation Cephalosporins (Table sa cephalosporin , 2): 3 kabuok, enumerate:cefadroxil (generic) Cefazolin (Zolicef) Cephalexin (Keflex)
Second-Generation Cephalosporins: Dosage/Route: Adult: 250 mg PO q8h--- do not exceed 4g/d; must be taken every 8-12 h around the clock Pediatric: 20 mg/kg/d PO in divided doses q8h; do not exceed 1g/d Usual Indications: Treatment of respiratory tract infections, skin infections, UTIs, otitis media, typhoid fever, anthrax exposure P or first to produceCefaclor (Ceclor)
Second-Generation Cephalosporins: Cefaclor (Ceclor): Dosage/Route: Adult:Dosage/Route: Adult: 250 mg PO q8h--- do not exceed 4g/d; must be taken every 8-12 h around the clock
Second-Generation Cephalosporins: Cefaclor (Ceclor): Dosage/Route: Pediatric:Pediatric: 20 mg/kg/d PO in divided doses q8h; do not exceed 1g/d
Second-Generation Cephalosporins: Cefaclor (Ceclor): Dosage/Route: Adult: Pediatric:Dosage/Route: Adult: 250 mg PO q8h--- do not exceed 4g/d; must be taken every 8-12 h around the clock Pediatric: 20 mg/kg/d PO in divided doses q8h; do not exceed 1g/d
Second-Generation Cephalosporins: Cefaclor (Ceclor): Usual Indications:Usual Indications: Treatment of respiratory tract infections, skin infections, UTIs, otitis media, typhoid fever, anthrax exposure
Second-Generation Cephalosporins: Dosage/Route: Adult: 1-2 g IM or IV q6-8h; reduce dose with renal impairment Pediatric: 80-160 mg/kg/d IM or IV in divided doses q4-6h Usual Indications: Treatment of sever infections; preoperative prophylaxis for cesarean section and abdominal, vaginal, biliary or colorectal surgery; more effective in gynecological and intra-abdominal infections than some other agents.Cefoxitin (generic)
Second-Generation Cephalosporins: Dosage/Route: Adult: 250-500mg PO q12h for 10 d; reduce dose with renal impairment Pediatric: 7.5-20 mg/kg PO q12h for 10d; for child 6 mo-2 y of age, 75-15 mg/kg PO q12h for 10 d Usual Indications: Treatment of pharyngitis, tonsilitis, otitis media, sinusitis, secondary bronchial infections, and skin infectionsCefprozil (generic)
Second-Generation Cephalosporins: Dosage/Route: Adult: 250 mg PO b.i.d.; 750 mg-1.5 g IM q8h; reduce dose with renal impairment Pediatric: 125-250 mg PO b.i.d.; 50-100 mg/kg/d IM or IV in divided doses q6-8h Usual Indications: Treatment of a wide range of infections as listed for other second-generation drugs; Lyme disease; preferred treatment in situations involving an anticipated switch from parenteral to oral drug use.cefuroxime (Zinacef)
Second-Generation Cephalosporins (sa cephalosporins nga table, 2):Cefaclor (Ceclor) Cefoxitin (generic) Cefprozil (generic) Cefuroxime (Zinacef)
Third-Generation Cephalosporins: Dosage/Route: Adult: 300 mg PO q12h for 10 d; reduce dose with renal impairment Pediatric: 7mg/kg PO q12h Usual Indications: Treatment of respiratory infections, otitis media, sinusitis, laryngitis, bronchitis, skin infectionsCefdinir (generic; a suspension form is available for children)
Third-Generation Cephalosporins: Dosage/Route: Adult: 2-8 g/d IM or IV in divided doses q6-q8h; reduce dose with renal impairment Pediatric: 50-180 mg/kg/d IM or IV in divided doses q4-q6h Usual Indications: Treatment of moderate to severe sin, urinary tract, and respiratory tract infections; pelvic inflammatory disease; intra-abdominal infections; peritonitis; septicemia; bone infections; central nervous system (CNS) infections; preoperative prophylaxiscefotaxime (Claforan)
Third-Generation Cephalosporins: Dosage/Route: Adult: 100-400 mg PO q12h; reduce dose with renal impairment Pediatric: 5-10 mg/kg PO q12h for 7-14 d Usual Indications: Treatment of respiratory infections, UTIs, gonorrhea, skin infections, and otitis mediaCefpodoxime (Vantin)
Third-Generation Cephalosporins: Dosage/Route: Adult: 1 g q8-12h IM or IV; reduce dose with renal impairment Pediatric: 30-50 mg/kg q8-12h IM or IV Usual Indications: Treatment of moderate to severe skin, urinary tract, and respiratory tract infections; intra-abdominal infections; septicemia; bone infections; CNS infectionsCeftazidime (Ceptaz, Tazicef)
Third-Generation Cephalosporins: Dosage/Route: Adult: 400 mg PO every day for 10 d; reduce dose with renal impairment Pediatric: 9 mg/kg/d PO for 10d Note: Once-a-day dosing increases compliance Usual Indications: Treatment of pharyngitis, tonsilitis, exacerbations of bronchitis, otitis mediaCefibuten (Cedax; available in a suspension form for children)
Third-Generation Cephalosporins: Dosage/Route: Adult: 500mg-2 g IM or IV q8-12h; reduce dose with renal impairment Pediatric: 50 mg/kg IM or IV q6-8h Usual Indications: Treatment of respiratory, gynecological, pelvic inflammatory, intra-abdominal, skin, and bone and joint infections; also used for sepsis and meningitisCefizoxime (Cefizox)
Third-Generation Cephalosporins: Dosage/Route: Adult: 1-2 g/d IM or IV in divided doses b.i.d.-q.i.d. Pediatric: 50-75 mg/kg/d IV or IM in divided doses q12h Usual Indications: Treatment of moderate to severe skin, urinary tract, and respiratory tract infections; pelvic inflammatory disease; intra-abdominal infections; peritonitis; septicemia; bone infections; CNS infections; preoperative prophylaxis; off-label use for treatment of Lyme disease.Ceftriaxone (Rocephin)
Fourth-Generation Cephalosporins: Dosage/Route: Adult & Pediatric: (>12 y); 200-400 mg PO b.i.d.; reduce dose with renal impairment Usual Indications: Treatment of acute exacerbations of chronic bronchitis; pharyngitis and tonsilitis; skin and skin-structure infectionsCefditoren (Spectracef)
Fourth-Generation Cephalosporins: Dosage/Route: Adult: 0.5-2 g IM or IV q12h; must be injected for greatest effectiveness q12h for 7-10 d; reduce dose with renal impairment Pediatric: 50 mg/kg per dose q12h IV or IM for 7-10 d Usual Indications: Treatment of moderate to severe skin, urinary tract and respiratory tract infectionsCefepime (Maxipime)
Fourth-Generation Cephalosporins: Dosage/Route: 600 mg IV over 1 h for 5-7 d community-acquired pneumonia or 5-14 d skin infections Usual Indications: Treatment of skin and skin-structure infections; community-acquired pneumoniaCeftaroline (Teflaro)
Cephalosporins: Therapeutic actions and indications: Cephalosporins are both ______ & ______, depending on dose and specific drug involvedbactericidal and bacteriostatic
Cephalosporins: Therapeutic actions and indications: Cephalosporins interferes with what of bacteria when they divide?Cephalosporins interferes with the cell wall-building ability of bacteria when they divide
Cephalosporins: Therapeutic actions and indications: Cephalosporins prevent the bacteria from biosynthesizing what? Bacteria weakened cell wall swell and burst as a result of osmotic pressure within the cell.Cephalosporins prevent the bacteria from biosynthesizing framework of cell walls
Cephalosporins: Therapeutic actions and indications: Selection of an antibiotic of this class depends on the?sensitivity of the involved organism, the route of choice, and sometimes the cost involved.
Cephalosporins: Therapeutic actions and indications: Important to reserve cephalosporins for appropriate situation because?cephalosporin-resistant bacteria are increasing in numbers.
Cephalosporins: Therapeutic actions and indications: Before therapy, perform 'what' to evaluate the causative organism and appropriate sensitivity to the antibiotic being used.perform C/S test or Culture and Sensitivity test
Cephalosporins: Pharmacokinetics: Well absorbed from?GI tract; others absorbed well after IM and IV administration
Cephalosporins: Pharmacokinetics: Are metabolized primarily in the? and excreted in the?Are metabolized primarily in the liver and excreted in the urine
Cephalosporins: Pharmacokinetics: Caution with ??? because either condition could alter drug metabolism and excretionhepatic or renal impairment
Cephalosporins: Pharmacokinetics: True or False: is a teratogen?Yes, Cephalosporins crosses placenta and breast milk
Cephalosporins: Pharmacokinetics: Can be used during pregnancy and lactation only if?benefit outweighs potential risk of toxicity of fetus or neonate
Cephalosporins: Contraindications and cautions: 1: Not to be used with patients with known allergy to what?Penicillin
Cephalosporins: Contraindications and cautions: 2: Caution with patient's suffering from what failure, to which it is toxic?Caution with pt's. suffering from kidney failure, toxic to kidneys
Cephalosporins: Contraindications and cautions: 3Pregnant and lactation mothers, though potential effects on the baby is not yet known
Cephalosporins Drug to Drug Interactions: Cephalosporins and aminoglycosides increases risk of what? -monitoring and evaluation of serum BUN and creatinine levelsnephrotoxicity
Cephalosporins Drug to Drug Interactions: With what drug interaction could experience increase bleedingoral anticoagulants
Cephalosporins Drug to Drug Interactions: If with alcohol after 72 hours after D/C (or discontinued) may cause?disulfram-like reaction
Cephalosporins Drug to Drug Interactions: Considerations:Take cephalosporin on an empty stomach, if gastric irritation occurs may take with food.
Relatively new synthetic class of antibiotics with broad spectrum activity. activity against gram (-),(+), atypical organisms.Flouroquinolones
Common fluoroquinolones are: highly active against gram (-) pathogens.Ciprofoloxacin, norfloxacin, & ofloxacin
Fluoroquinolones: Are enhanced activity against gram (+) pathogens while maintaining similar gram (-) activity. Made synthetically, with mid adverse reactions.New fluoroquinolones
What fluoroquinolone is widely used? 500-750 mg p.o.; 2mg/100ml IV is widely used -effective against wide spectrum gram (-) bacteria. -available in IM, IV, PO, topical forms -approved for prevention of anthrax infection in the area that might be exposed to germ warfare. -effective against RTI, middle ear, sinuses, genital organs, etc.Ciprofloxacin (Ciprobay)
Fluoroquinolones: Are oral agents:Gemifloxacin, lomefloxacin, and moxifloxacin
Fluoroquinolones: Is available in oral and IV forms:Levofloxacin
Fluoroquinolones: can be given IV or or al and also available as an ophthalmic agent for the treatment of ocular infections caused by susceptible bacteria.Ofloxacin
Fluoroquinolones: The newest drug, available in otic drops for topical treatment of swimmer's ear.Finafloxacin
Fluoroquinolones: Dosage/Route: Adult: 100-500 mg b.i.d. PO for up to 6 wk; reduce dose in renal failure Pediatric: not recommended because of potential effects on developing cartilage. Usual indications: Treatment of infections caused by a wide spectrum of gram-negative bacteria.Ciprofloxacin (Cipro)
Fluoroquinolones: Dosage/Route: Adult: 320 mg/d PO for 5-7 d Usual Indications: Treatment of acute exacerbations of chronic bronchitis, community-acquired pneumoniaGemifloxacin (Factive)
Fluoroquinolones: Dosage/Route: Adult: 250-750 mg/d PO or intravenous (IV); reduce dose in renal impairment After exposure to anthrax: 500 mg/d PO or IV for 60 d Usual Indications: Treatment of respiratory, urinary tract, skin, and sinus infections caused by susceptible gram-negative bacteria in adults; treatment after exposure to anthraxLevofloxacin (Levaquin)
Fluoroquinolones: Dosage/Route: Adult: 400 mg/d PO or IV for 5-10 d; reduce dose in renal impairment Usual Indications: Treatment of adults with sinusitis, bronchitis, or community-acquired pneumoniaMoxifloxacin (Avelox)
Fluoroquinolones: Dosage/Route: Adult: 400 mg PO q12h for up to 28 d; reduce dose in renal impairment Usual Indications: Treatment of various urinary tract infectionsNorfloxacin (Noroxin)
Fluoroquinolones: Dosage/Route: Adult: 200-400 mg q12h PO for up to 10 d; reduce dose in renal impairment Usual Indications: Treatment of respiratory, skin, and urinary tract infections; pelvic inflammatory disease; ocular infections; otic form available for otitis media.Ofloxacin (Floxin, Ocuflox)
Fluoroquinolones: Therapeutic actions and indications: 1: Fluoroquinolones enter the bacterial cell wall by?passive diffusion through cannels in the cell membranes
Fluoroquinolones: Therapeutic actions and indications: 2: Once inside, they interfere with? Leading to cell death because the bacterial cell wall is damaged, disrupting bacterial activity.the action of DNA enzymes necessary for growth and reproduction of bacteria.
Fluoroquinolones: Therapeutic actions and indications: 3: Not recommended for use in? because?not recommended for use in children below 18 years old because of associated lesions in developing cartilage.
Fluoroquinolones: Therapeutic actions and indications: are indicated for treating infections:UTI's, prostatitis, gonorrhea, anthrax, pneumonia, other RTI and infections of bones and joints
Fluoroquinolones: Pharmacokinetics:absorbed in GI tract -> metabolized in liver-> excreted in urine and feces
Fluoroquinolones: Pharmacokinetics: Widely distributed and; is it a teratogen?Widely distributed in the body and cross the placenta and enter the breast milk
Fluoroquinolones: Pharmacokinetics: Caution with patients with?renal and hepatic impairment, w/c could interfere w/ metabolism and excretion
Fluoroquinolones: Contraindications and cautions: 1:Known allergy to any fluoroquinolones, pregnant and lactating women because of unknown effects on fetuses and infants
Fluoroquinolones: Contraindications and cautions: 2: Decrease the absorption & should not be given 2 hours following administration of the antibioticAntacids
Fluoroquinolones: Contraindications and cautions: Caution with what? w/c could interfere drug excretion and seizure, w/c could be exacerbated by the drugs effects on cell membrane channelsRenal dysfunction
Fluoroquinolones: Adverse effects: 1: Generally associated with relatively mild adverse reactions:Headache, dizziness, insomnia, and depression related to direct drug effects on the GI tract and possible stimulation of the chemoreceptor trigger zone in the CNS.
Fluoroquinolones: Adverse effects: 2: GI effects include:nausea, vomiting, diarrhea, and dry mout.
Fluoroquinolones: Adverse effects: 3: Immunological effects include:bone marrow depression
Fluoroquinolones: Adverse effects: 4: Other adverse effects are:fever, rash, photosensitivity.
Fluoroquinolones: Adverse effects: 5: Instruct the patient to:avoid sun and ultraviolet light exposure and to use protective clothing and sunscreens.
Fluoroquinolones: Drug to drug interactions: When taken with what? the therapeutic effects decreases.iron salts, sucralfate, mineral supplements or antacids
Fluoroquinolones: Drug to drug interactions: If administration of 2 agents is necessary, should be taken?4 hours separated
Fluoroquinolones: Drug to drug interactions: Should not be taken with:milk or other dairy products, antacids, magnesium laxatives, and iron supplements
Fluoroquinolones: Drug to drug interactions: Fatal cardiac reactions causing torsades de pointes if taken with:quinidine, procainamide, amiodarone, sotalol, erythromycin, terfenadine, pentamidine, tricyclics, phenothiazines should be avoided unless hospitalized with cardiac monitoring
Fluoroquinolones: Drug to drug interactions: Increase fluid intake ->:high urine output, preventing crystalluria
Fluoroquinolones: Drug to drug interactions: if with combination with Theophylline, leads to increased theophylline levels, because?they are the same metabolic pathways
Fluoroquinolones: Drug to drug interactions: Theophylline dose should be:decreased by half and serum theophylline should be monitored.
Fluoroquinolones: Drug to drug interactions: If combined with NSAID's:risk of stimulation, especially those with seizures and be monitored closely.