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Antiinfective Agents By Jim Clarke Aerosolized

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Antiinfective Agents By Jim Clarke Aerosolized Anti-infectives 2 occasionally used agents Pentamidine (NebuPent) Ribavirin (Virazole) Indications for Pentamidine ... – PowerPoint PPT presentation

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Title: Antiinfective Agents By Jim Clarke Aerosolized


1
Antiinfective Agents
  • By Jim Clarke

2
Aerosolized Anti-infectives
  • 2 occasionally used agents
  • Pentamidine (NebuPent)
  • Ribavirin (Virazole)

3
Indications for Pentamidine
  • History of one or more episodes of PCP
  • A low CD4 lymphocyte count

4
Rationale for Administration
  • Aerosol administration delivers drug to area of
    lung most likely to be affected
  • Parenteral administration has numerous side
    effects
  • Aerosol administration produces higher blood
    levels than parenteral

5
Side Effects of Aerosol Pentam
  • Cough bronchial irritation
  • SOB
  • Bitter taste (burning in mouth)
  • Bronchospasm wheezing
  • Conjunctivitis

6
Dosing Issues
  • Use nebulizer designed for Pentam use
  • Should produce particles in 1-2 micron range
  • Should have one-way valves directing exhalation
    through filter
  • Give tx in negative pressure booth or room

7
Dosing Issues
  • Pregnant or nursing mothers should avoid contact
  • Use gloves, mask eyewear

8
Ribavirin
  • Classification
  • Anti-viral agent that works against RSV
    (Respiratory Syncytial Virus), influenza herpes
    simplex
  • Indications
  • Given via inhalation to children suffering from
    RSV
  • Only given if patient has severe bronchiolitis
    with moderate to severe hypoxemia

9
Side Effects
  • Pulmonary
  • Deterioration of pulmonary function pneumothrax
    bacterial infection
  • Cardiovascular
  • Hypotension cardiac arrest
  • Topical
  • Rash eyelid erythema conjunctivitis

10
Dosing Issues
  • Virazole must be given with SPAG nebulizer
  • Generally given via head-hood
  • Can be given via ventilator

11
Aerosolized Antibiotic Use
  • In Cystic Fibrosis
  • Has become a popular method for prevention of
    pneumonia
  • Prevents outbreaks of Pseudomnas aeruginosa,
    Hemophilus influenzae Staphylococcus aureus
  • Gentamicin

12
Non-Aerosolized Antibiotics
13
Definitions
  • Antibiotic is a substance produced by
    microorganisms that is capable of inhibiting or
    killing bacteria and other microorganisms
  • Mode of Action - how the antibiotic actually
    kills the targeted microorganisms

14
Antibiotic Terms
  • Bacteriostatic- a drug that inhibits the growth
    of a microorganism
  • Bactericidal is a drug that kills the
    microorganism
  • Broad Spectrum - a drug that works on a wide
    variety of organisms
  • Narrow Spectrum - a drug that works only only a
    few organisms

15
How Antibiotics Work
16
Inhibition of Cell Wall Synthesis
  • These antibiotics prevent normal cell wall
    formation
  • Examples of these antibiotics
  • Penicillans
  • Bacitracin
  • Cephalosporins
  • Vancomycin

17
Alteration of Cell Membrane Permeability
  • Disruption of cell wall filtering causes cellular
    death
  • Examples
  • Polymyxin B

18
Inhibition of Protein Synthesis
  • Prevention of the ribosomes ability to make
    necessary proteins
  • Examples
  • Gentamicin
  • Erthromycin
  • Streptomycin
  • Tetracyclines

19
Inhibition of Nucleic Acid Synthesis
  • Prevents DNA replication or formation of
    messenger RNA
  • Examples
  • Cipro
  • Trimethoprim
  • Sulfonamides
  • Rifampin

20
Antibiotic Sensitivity Resistance
  • Sensitivity - measures how well the antibiotic
    inhibits or kills
  • Resistance - describes an organisms ability to
    inactivate the antibiotic

21
Penicillins
  • Inhibit cell wall formation
  • Numerous forms available - generic agents always
    end with cillin
  • Numerous strains of Staph. Aureus, E. coli,
    Proteus and pseudomonas species are resistant to
    penicillans
  • Nafcillan is now the only agent that generally
    works on Staph. Aureus
  • Penicillans used to treat Strep., some Staph and
    Haemophilus influenzae infections

22
Cephalosporins
  • Broken into 3 categories
  • First generation - active on gram organisms
  • Second generation - more active on gram -
    organism
  • Third generation - variable against gram
    more active against gram -

23
Cephalosporins cont.
  • Nephrotoxicity can occur causing renal necrosis

24
Aminoglycosides
  • Act by prevention of normal protein synthesis
  • Used to treat many gram - pneumonias
  • Examples
  • Gentamicin, Tobramycin Amikacin
  • Inhalation used in tx of Pseudomonas pneumonias
    in Cystic Fibrosis
  • These agents can be extremely nephrotoxic

25
Tetracyclines
  • Act by interfering with protein synthesis
  • Broad spectrum
  • Used to treat atypical pneumonias
  • Mycoplasma pneumoniae
  • Cause GI irritation nausea, diarrhea
  • Should not be used with children except for short
    periods - (tooth discoloration)

26
Fluoroquinolones
  • Broad Spectrum
  • Inhibition of DNA synthesis
  • Used widely in COPD Cystic Fibrosis
  • Pseudomonas Aeruginosa
  • Examples
  • Cipro (Ciprofloxacin)
  • Noroxin (Norfloxacin_

27
Macrolides (Etythromycins)
  • Inhibit protein synthesis
  • Drug of choice for treatment of Mycoplasma
    Legionella infections
  • Oral administration can cause GI upset
  • Examples
  • Biaxin
  • Zithromax

28
Sulfonamides
  • Inhibit nucleic acid synthesis
  • Not really an antibiotic!
  • Used mainly to treat urinary some intestinal
    infections
  • Trimethoprim-Sulfamethoxazole combination used to
    treat Pneumocystis carinii pneumonia

29
Miscellaneous Antibiotics
30
Vancomycin
  • Reserved mainly for use in treating
    methicillin-resistant S. aureus (MRSA)
  • Can be toxic to the kidneys ears
  • There are now strains of Enterobacter that are
    resistant to Vancomycin (VRE)

31
Chloramphenicol
  • Very rarely used due to chances of causing
    aplastic anemia
  • Only used in cases of life-threatening infections
    resistant to other antibiotics

32
Flagyl
  • Used as an antiprotozoal agent to treat GI
    infections most anaerobes

33
Nitrofurantoin (Furadantin)
  • Synthetic agent (not a true antibiotic)
  • Broad Spectrum agent
  • Used mainly in tx of urinary tract infections
  • Can cause pulmonary side effects
  • pleural effusions and infiltrates

34
Antifungal Agents
  • Amphotericin B
  • Has severe toxic side effects - nephrotoxicity
    fever decreased BP
  • Can cause metabolic acidosis!
  • Nystatin
  • Topical treatment for Candida albicans infections

35
Anti-Tuberculosis Drugs
36
End of this session
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