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Chapter 4

Chapter 4. Antibiotics. Chapter 4 Topics. Bacteria How Antibiotics Work Classes of Antibiotics Antibiotics Independent of Classes Adjunct in Treating Sepsis Discussion Questions. Learning Objectives. Identify the major types of antibiotics by drug class.

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Chapter 4

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  1. Chapter 4 Antibiotics

  2. Chapter 4 Topics • Bacteria • How Antibiotics Work • Classes of Antibiotics • Antibiotics Independent of Classes • Adjunct in Treating Sepsis • Discussion Questions

  3. Learning Objectives • Identify the major types of antibiotics by drug class. • Know which auxiliary labels to use when dispensing major types of antibiotics. • Define therapeutic effects, side effects, andadministration routes of major antibiotics. • Use antibiotic and general drug terminology correctly in written and oral communications.

  4. Fighting Bacterial Infections • Bacteria: microorganisms that cause infection • Bactericidal agent: kills the invading organism • Bacteriostatic agent: inhibits the growth or multiplication of bacteria

  5. Types of Bacteria • Aerobic bacteria • Anaerobic bacteria

  6. Types of Bacteria • Aerobic bacteria needs oxygen to survive • Anaerobic bacteria survives in the absence of oxygen

  7. Bacteria Shapes (a) Round cocci (b) Rod-like bacilli (c) Spiral-shaped spirochetes

  8. Gram’s Stain Results and Related Diseases

  9. Gram’s Stain Results and Related Diseases

  10. Gram’s Stain Results and Related Diseases

  11. How Antibiotics Work • Block protein formation

  12. How Antibiotics Work • Block protein formation • Macrolides • Tetracyclines • Aminoglycosides

  13. How Antibiotics Work • Block protein formation • Inhibit cell wall formation

  14. How Antibiotics Work • Block protein formation • Inhibit cell wall formation • Penicillins • Cephalosporins

  15. How Antibiotics Work • Block protein formation • Inhibit cell wall formation • Interfere with DNA formation

  16. How Antibiotics Work • Block protein formation • Inhibit cell wall formation • Interfere with DNA formation • Nalidixic acid

  17. How Antibiotics Work • Block protein formation • Inhibit cell wall formation • Interfere with DNA formation • Prevent folic acid synthesis

  18. How Antibiotics Work • Block protein formation • Inhibit cell wall formation • Interfere with DNA formation • Prevent folic acid synthesis • Sulfonamides

  19. Antibiotic Dispensing Issues • Mix exactly as directed by manufacturer • Swab counting tray with alcohol between drugs to prevent cross-contamination Warning!

  20. Antibiotic Side Effects • Most antibiotics should be taken on an empty stomach to attain faster absorption

  21. Antibiotic Side Effects • Most antibiotics should be taken on an empty stomach to attain faster absorption • Examples of exceptions • nitrofurantoin (Macrobid, Macrodantin) • cefuroxime (Ceftin, Zinacef)

  22. Antimicrobial Resistance • Developing largely because of • overuse • misuse

  23. Antimicrobial Resistance • Developing largely because of • overuse • misuse • The Pharmacy Technician’s role • Place an label on antibiotics advising the patient to take all of the medication

  24. Discussion How might the widespread use of antibacterial soaps affect the population?

  25. Sulfonamides Penicillins Cephalosporins Tetracyclines Macrolides Ketolides Quinolones Streptogramins Aminoglycosides Cyclic Lipopetides Classes of Antibiotics

  26. Sulfonamides • AKA “sulfa drugs” • Effective against a broad range of microorganisms • Block specific step in biosynthetic pathway of folic acid • Interfere with PABA and folic acid formation, thereby destroying bacteria

  27. Drug List Sulfonamides and Related Drugs • nitrofurantoin (Macrobid, Macrodantin) • sulfamethoxazole-trimethoprim (Bactrim DS, Septra DS) • sulfisoxazole (Gantrisin)

  28. Sulfonamides • If patient is allergic to sulfa….

  29. Sulfonamides • If patient is allergic to sulfa…. nitrofurantoin (Macrobid, Macrodantin)

  30. Therapeutic Uses of Sulfonamides • Urinary tract infections (UTIs) • Otitis media • Ulcerative colitis • Lower respiratory infections • Prophylaxis in Pneumocystis carinii pneumonia in immunocompromised patients

  31. Sulfonamides’ Side Effects • Rash • Nausea • Drug fever • Vomiting • Jaundice • Blood complications • Kidney damage

  32. Sulfonamides’ Dispensing Issues • Avoid the sun • Maintain adequate fluid intake

  33. Penicillins • Low toxicity • Effective derivatives created from manipulating drug’s basic molecular structure • Kills bacteria by preventing them from forming the rigid cell wall • Because human cells do not have cell walls, they are not affected

  34. Drug List Penicillins • amoxicillin (Amoxil, Trimox) • amoxicillin-clavulanate (Augmentin) • ampicillin (Principen) • ampicillin-sulbactam (Unasyn) • carbenicillin (Geocillin)

  35. Drug List Penicillins • dicloxacillin • nafcillin • oxacillin • penicillin G (various) • penicillin V (Veetids) • piperacillin

  36. Drug List Penicillins • piperacillin-tazobactam (Zosyn) • ticarcillin (Ticar) • ticarcillin-clavulanate (Timentin)

  37. Therapeutic Uses of Penicillins • Abscesses • Beta-hemolytic streptococcus • Meningitis • Otitis media • Pneumonia • Respiratory infections • Tooth and gum infections • Venereal diseases (syphilis and gonorrhea) • Endocarditis due to streptococci

  38. Penicillins’ Side Effects • Diarrhea • Allergies in 7% to 10% of population

  39. Penicillins’ Dispensing Issues • Take on an empty stomach • Food slows absorption • Acids in fruit juices or colas could deactivate the drug

  40. Penicillin Resistance • Penicillinase-resistant penicillins work against gram-positive aerobes • Extended-spectrum penicillins are more resistant to gram-negative bacteria • Penicillin combinations improve effect

  41. Cephalosporins • Have a mechanism of action similar to penicillins • A person allergic to penicillin, about 10% chance of being allergic

  42. Cephalosporins Alert the Pharmacist if a patient allergic to penicillins is receiving a cephalosporin prescription. Warning!

  43. Cephalosporins • First-generation

  44. Cephalosporins • First-generation • Similar to penicillinase-resistant penicillins with greater gram-negative coverage • Used for • community-acquired infections • mild to moderate infections

  45. Cephalosporins • Second-generation

  46. Cephalosporins • Second-generation • Increased activity, especially against Haemophilus influenzae • Used for • Otitis media in children • Respiratory infections • UTIs

  47. Cephalosporins • Third-generation

  48. Cephalosporins • Third-generation • Active against a wide spectrum of gram-negative organisms • Long half-life, so once-a-day dosing for some • Used for • Ambulatory patients • Children (dosing before or after school)

  49. Cephalosporins Side Effects • Share side effects of penicillin • Few may initiate unique toxic reactions • Lower frequency of toxicity than many other antibiotics

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