signs of a viral infection don’t occur until after virus has left __clinically “the cell”
stop penetration of virus stop intracellular synthesis & the release of a new virusantiviral agents stop viruses 3 ways
used 2 TX RSV {common <2yrsold}ribavirin {virazole}
Ribavirin {Virazole} is a __antiviral
dose 600mg in 6mL sterile water give a bronchodilator be4 admin.. used 1x/month as prophylactic TX for HIV/post cancer pt; or allergic to bactrium; premixed aerosolizedantimicrobial= pentimidine {nebupent, pentam} or colistin {gentamicin}
aNTIFUNGAL DRUGS USED TO tx POST LUNG TRANSPLANT PT or infections; premixed; NEVER GIVE AS IV; 300mg BIDtobramycin {TOBI}
anti-fungal drug never given IVamphotericin
When did the “antibiotic era” begin?In the 1940’s with Penicillin.
What is chemotherapy?The application of a chemical agent that has specific toxic effects on disease producing organisms in a living animal.
What is an antibiotic?a chemotherapeutic substance derived from a living organism that kills microorganism growth
What is a pathogen?A disease-causing microorganism.
What is normal flora?normally harmless microbial organisms in the body.
What is empiric therapy?antimicrobial therapy begun before a specific pathogen has been identified with laboratory tests.
What are the steps of the infectious process?1. Establish the presence of infection. 2. Determine where the infection is located. (is it systemic or local) 3.Determine course of therapy.
What information is used to establish the presence of an infection?Signs and symptoms Subjective and objective information
What can systemic infections cause?Since systemic infections may spread to the blood stream it can cause multisystem problems.
What kind of therapy to systemic infections require?A more aggressive therapy.
What is the suspected respiratory infection pathogen for croup?Parainfluenza virus Staphylococcus aureus
What is the suspected respiratory infection pathogen for epiglottitis?Haemophilus influenza
How is bacteria identified?As aerobic bacteria or anaerobic bacteria.
Aerobic bacterianeed oxygen to survive
anaerobic bacteriado not need oxygen to survive
How do you test and identify for bacteria?gram stain
What are susceptibility testing methods?Disk diffusion Broth dilution
Who performed the first-gram stain test?Hans Christian Gram
How does the test determine chemical make up?By looking at the cell wall
What does the cell wall function to do?Maintain integrity and protect the bacteria. This is the site of action for many antibiotics.
What color does gram positive stain?purple
What is a gram positive wall like?It is composed of a uniform monolayer of peptidoglycans.
Are gram positive cells harder or easier to kill?Easier due to the monolayer
What color is the gram negative stain?pink
What does the cell wall of a gram look like?Multiple layers, including an outer membrane and an inner peptidoglycan layer
when does susceptibility testing begin?After the organism is already identified.
What does susceptibility testing help to do?guide antibiotic therapy
What are the two methods to determine susceptibility?Disk diffusion and broth dilution.
Disk diffusionA class technique Qualitative Bacteria cultured and grown on a solid media. Antibiotic-containing paper disks
The disk diffusion method has what?Zone of inhibition Resistant bacteria
Broth Dilutionmore quantitative accurately identify the concentration of drug needed to inhibit or kill bacteria. Involves test tubes
MIC (minimal inhibitory concentration)The test tube with the lowest concentration of antimicrobial agent that inhibits the growth of the organism.
MBC (minimum bactericidal concentration)Determins whether the organism is actually killed
What are the Gram + bacteria?Streptococci Staphylococci (Everything else is Gram -)
What are broad spectrum antibiotics?Antibiotics that kill a variety of bacteria
What are narrow spectrum antibiotics?Antibiotics that are effective against fewer microorganisms. They are more specific.
ResistanceBacterial enzymes can bind to a drug Enzymes can bind to a drug and prevent the drug from attaching to bacteria. Patients do not finish anti-infective treatment
How do you monitor anti-infective therapy?Clinical response Microbiological response (secondary blood/sputum culture Drug levels: TI/Toxicity
How are agents classified?bacteriostatic or bacteriocidal Broad or Narrow Mechanism of action antibacterial agents (classes)
DPI: 10mg bid x 5 daysRelenza
SVN: 75 mg tid 28 days on / 28 days offCaystan
SVN: 300mg/5ml ampouleTOBI
SVN:300mg of powder and 6 ml of NS; 300mg once q 4 weeksNebupent
SVN: 6mg of powder in 300 ml of NS q 12-18hrs x 5 daysVirazole
VancomycinUsed to treat MRSA
RibavirinTreats RSV
PentamidineTreats PCP prophylaxis
TobramycinTreats Pseudomonas aeruginosa in CF
AztreonamTreats Pseudomonas aeruginosa in CF
ZanamivirTreats acute uncomplicated influenza
Name the drugs that are used in the treatment of TB.Isoniazid, Rifampin-Rifabutin, Pyrazinamide, Ethambutol, Streptomycin
Are these drugs aerosolized?No.
How long does the patient have to take antimycobacterial for TB?6 mos-1 yr
What are the names of the antifungal drugs?Fluconazole-Diflucan, Itraconazole-Sporanox, Amphotericin B
What is the 4th most common pathogen in the bloodstream?Candida albicans
In what unit of the hospital is the use of antifungal drugs common?ICU
What is Terbinafine/Lamisil used for?athlete’s foot
What are the gram positive bacteria?Staphylococcus, MRSA, Streptococcus
What are the gram-negative bacteria?Pseudomonas, Klebsiella, Hemophilus
What are the main reasons to aerosolize antibiotics?Direct target, Decreased side effects
What are some FYI facts about aerosolizing antibiotics?seperate neb, andreconstitute with sterile distilled water
In what specific order should treatments be when administering antibiotics?Bronchdilator, Mucolytic, CPT, antibiotic/steriod
What are the antibiotics that can be aerosolized?Aminoglycoside, Tobramycin, gentamicin
What organism do Aminoglycosides and TOBI treat?Gram negative infections like:P.aeruginosa, VAP