Pharm Quiz Prep 1

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Questions and Answers

What is tuberculosis?

  • A type of bacteria found in water and soil
  • A non-infectious disease that causes lung damage
  • Infectious disease primarily affecting lungs and other organs (correct)
  • A fungal infection that affects the respiratory system

What does MAC stand for?

  • Mycobacterium avium Complete
  • Mycobacterium avium Control
  • Mycobacterium avium Complex (correct)
  • Mycobacterium avium Cure

Latent tuberculosis infection is a symptomatic condition.

False (B)

Which of these is a sign of active tuberculosis?

<p>All of the above (E)</p> Signup and view all the answers

What is the main way tuberculosis is transmitted?

<p>Through inhalation of droplets (D)</p> Signup and view all the answers

Multidrug-resistant tuberculosis (MDR-TB) is resistant to most effective anti-TB medications.

<p>True (A)</p> Signup and view all the answers

What is the primary goal of drug therapy for tuberculosis?

<p>Cure the infection</p> Signup and view all the answers

Sputum cultures are used to test for TB bacteria in urine samples.

<p>False (B)</p> Signup and view all the answers

What is one of the key factors influencing the success of TB treatment?

<p>Adherence to therapy</p> Signup and view all the answers

Which of these is a risk factor for developing tuberculosis?

<p>All of the above (D)</p> Signup and view all the answers

HIV infection increases the risk of developing active tuberculosis.

<p>True (A)</p> Signup and view all the answers

Which of these is a first-line agent used to treat tuberculosis?

<p>All of the above (E)</p> Signup and view all the answers

Second-line medications are used when first-line drugs are ineffective in treating TB.

<p>True (A)</p> Signup and view all the answers

What is one important strategy for TB control?

<p>Educate and support patients for treatment adherence.</p> Signup and view all the answers

What is Erythromycin?

<p>The prototype macrolide with broad tissue distribution.</p> Signup and view all the answers

What does 'Bacteriostatic' mean?

<p>Prevents bacterial growth (A)</p> Signup and view all the answers

What does 'Bactericidal' mean?

<p>Kills bacteria (D)</p> Signup and view all the answers

Macrolides are effective against Gram(+) cocci bacteria.

<p>True (A)</p> Signup and view all the answers

What is the class of antibiotics that include erythromycin?

<p>Macrolide Antibacterials</p> Signup and view all the answers

What does 'Pharmacokinetics' refer to?

<p>The study of drug absorption, distribution, metabolism, and excretion.</p> Signup and view all the answers

Which of these conditions can affect drug metabolism?

<p>Both A and B (D)</p> Signup and view all the answers

What are 'Adverse effects'?

<p>Unwanted reactions from medication use.</p> Signup and view all the answers

What are 'Contraindications'?

<p>Conditions preventing safe drug use (A)</p> Signup and view all the answers

What is Fidaxomicin?

<p>A macrolide primarily for C. difficile infections.</p> Signup and view all the answers

What is Tedizolid?

<p>An Oxazolidinone effective against resistant bacteria.</p> Signup and view all the answers

What is Telavancin?

<p>A Lipoglycopeptide for skin and soft tissue infections.</p> Signup and view all the answers

What is Tigecycline?

<p>A Glycylcycline for multi-drug resistant infections.</p> Signup and view all the answers

What is Vancomycin?

<p>A Glycopeptide antibiotic for serious infections.</p> Signup and view all the answers

What are Culture and susceptibility reports?

<p>Tests to identify bacterial resistance.</p> Signup and view all the answers

Which of the following best describes 'Narrow spectra of activity'?

<p>Effective against a limited range of bacteria (B)</p> Signup and view all the answers

What is 'Patient teaching'?

<p>Educating patients on medication use and effects.</p> Signup and view all the answers

What type of infections do aminoglycosides treat?

<p>Serious gram-negative infections</p> Signup and view all the answers

What is the prototype aminoglycoside antibiotic?

<p>Gentamicin</p> Signup and view all the answers

Fluoroquinolones are only effective against gram-negative organisms.

<p>False (B)</p> Signup and view all the answers

What is the prototype fluoroquinolone antibiotic?

<p>Ciprofloxacin</p> Signup and view all the answers

What type of agents are aminoglycosides and fluoroquinolones?

<p>Bactericidal (A)</p> Signup and view all the answers

Aminoglycosides are well absorbed orally.

<p>False (B)</p> Signup and view all the answers

What type of administration is used for aminoglycosides?

<p>Parenteral</p> Signup and view all the answers

What is a potential side effect of high aminoglycoside concentrations?

<p>Nephrotoxicity</p> Signup and view all the answers

What is another potential side effect of aminoglycosides?

<p>Ototoxicity</p> Signup and view all the answers

Aminoglycosides are metabolized in the liver before excretion.

<p>False (B)</p> Signup and view all the answers

How do aminoglycosides exert their mechanism of action?

<p>By inhibiting bacterial protein synthesis</p> Signup and view all the answers

What are some examples of serious infections treated with aminoglycosides?

<p>Septicemia and meningitis</p> Signup and view all the answers

What is the chemical structure essential for antibacterial activity in beta-lactam antibacterial agents?

<p>Beta-Lactam Ring</p> Signup and view all the answers

Beta-lactam antibiotics are effective against all types of infections.

<p>False (B)</p> Signup and view all the answers

Which of the following is the first developed antibiotic group?

<p>Penicillins (A)</p> Signup and view all the answers

What is the primary mechanism of action for beta-lactam antibacterial agents?

<p>Inhibition of bacterial cell wall synthesis</p> Signup and view all the answers

Cephalosporins are derived from fungi.

<p>True (A)</p> Signup and view all the answers

What are beta-lactamase inhibitors used for?

<p>To protect penicillins from destruction by enzymes</p> Signup and view all the answers

Which of the following are examples of extended-spectrum penicillins?

<p>Amoxicillin (B)</p> Signup and view all the answers

What is the primary clinical indication for beta-lactam antibacterial agents?

<p>Surgical prophylaxis and various infections</p> Signup and view all the answers

Allergic reactions to penicillins are a contraindication for cephalosporin use due to cross-sensitivity.

<p>True (A)</p> Signup and view all the answers

Beta-lactam antibiotics are bacteriostatic, meaning they inhibit bacterial growth.

<p>False (B)</p> Signup and view all the answers

What does rapid excretion of drugs, such as many beta-lactam antibiotics, mean?

<p>The drugs are quickly eliminated from the body via the kidneys.</p> Signup and view all the answers

What is the primary concern with the increasing resistance incidence of beta-lactam antibiotics?

<p>The effectiveness of these antibiotics is being compromised, making it more difficult to treat bacterial infections effectively.</p> Signup and view all the answers

Surgical prophylaxis is a preventive approach using antibiotics during surgery to reduce the risk of infection.

<p>True (A)</p> Signup and view all the answers

What is septicemia?

<p>A blood infection that requires immediate and aggressive antibiotic treatment.</p> Signup and view all the answers

What groups are considered special populations when administering antibiotics?

<p>All of the above (D)</p> Signup and view all the answers

What are the key factors considered when selecting a drug for a specific infection?

<p>The severity of the infection and the causative organism.</p> Signup and view all the answers

What is pain?

<p>An unpleasant, uncomfortable sensation that usually indicates tissue damage.</p> Signup and view all the answers

What are opioid analgesics?

<p>Drugs that provide pain relief by affecting people's perception and tolerance of moderate to severe pain.</p> Signup and view all the answers

What are some causes of pain?

<p>Nerve damage, tissue injury, cancer, and surgery.</p> Signup and view all the answers

What are nociceptors?

<p>Pain receptors in peripheral nerves that are activated by tissue damage.</p> Signup and view all the answers

How do pain signals travel to the brain?

<p>Signals must travel from nociceptors in peripheral tissue to the spinal cord and then to the brain.</p> Signup and view all the answers

What is endogenous analgesia?

<p>The CNS's own system for relieving pain by suppressing pain signals from peripheral nerves.</p> Signup and view all the answers

What is the gold standard of pain assessment measurement?

<p>Self-reporting.</p> Signup and view all the answers

How do opioid analgesics work?

<p>Opioid analgesics inhibit adenylate cyclase, reduce perception of pain sensations in the brain, decrease emotional upset, and inhibit production of pain and inflammation.</p> Signup and view all the answers

What is the prototype opioid analgesic?

<p>Morphine sulfate.</p> Signup and view all the answers

What is patient-controlled analgesia (PCA)?

<p>A method of pain management that allows patients to control their pain relief.</p> Signup and view all the answers

What is the duration of action for morphine sulfate?

<p>5 to 7 hours.</p> Signup and view all the answers

What are the main administration routes for morphine sulfate?

<p>Oral (PO), intramuscular (IM), subcutaneous, and intravenous (IV).</p> Signup and view all the answers

What is tolerance in relation to opioid analgesics?

<p>A condition that develops with the use of opioid analgesics, requiring higher doses to achieve the same effect.</p> Signup and view all the answers

What are the main subgroups of opioids?

<p>Opioid agonists, agonists/antagonists, and antagonists.</p> Signup and view all the answers

Which of the following are examples of measurement tools for pain?

<p>Visual analog scales (B), Picture scales (C), Verbal or numerical rating scales (D)</p> Signup and view all the answers

What do opioid agonists do?

<p>Bind to receptors to block transmission of pain impulses.</p> Signup and view all the answers

Which of the following are major types of opioid receptors?

<p>Delta (A), Kappa (C), Mu (D)</p> Signup and view all the answers

Which of the following are effects of opioid agonists?

<p>Physical dependence (A), Sedation (B), CNS depression (C), Euphoria (D), Analgesia (F), Respiratory depression (G), Decreased gastrointestinal motility (H)</p> Signup and view all the answers

What are opioid agonists used for?

<p>Prevent or relieve moderate to severe acute or chronic pain.</p> Signup and view all the answers

For which conditions are opioid agonists used?

<p>Postoperative states (A), Cancer (B), Other traumatic injuries (C), Acute MI (D), Burns (E), Biliary or renal colic (G)</p> Signup and view all the answers

What are the indications for opioid use?

<p>Pre- and postoperative sedation (A), Decreases amount of anesthesia needed (B), Facilitates anesthesia induction (C), Decreased anxiety (D)</p> Signup and view all the answers

Labor and delivery is an indication for opioid use.

<p>True (A)</p> Signup and view all the answers

Treatment of acute pulmonary edema is an indication for opioid use.

<p>True (A)</p> Signup and view all the answers

Treatment of GI disorders is NOT an indication for opioid use.

<p>False (B)</p> Signup and view all the answers

Treatment of severe, unproductive cough is an indication for opioid use.

<p>True (A)</p> Signup and view all the answers

Which of the following are contraindications for opioid use?

<p>Concurrent use of MAOs (A), Upper airway obstruction (B), Pregnancy (C), Existing respiratory depression (D), Acute or chronic lung disease (F), Hypersensitivity to opioids (G)</p> Signup and view all the answers

Which of the following are cautions for opioid use?

<p>Increased intracranial pressure and head injury (A), Liver or kidney disease (B), Severe alcoholism (C), Thyroid dysfunction (E), Benzodiazepines or other CNS depressants (F), Hypotension (G), Seizure disorder (H)</p> Signup and view all the answers

Why are most opioid analgesics Schedule II drugs?

<p>Because they may lead to drug abuse or dependence.</p> Signup and view all the answers

What is butorphanol?

<p>Prototype opioid agonist/antagonist, synthetic, Schedule IV, with administration peaking in 30 to 60 minutes.</p> Signup and view all the answers

What are opioid agonists/antagonists used for?

<p>For moderate to severe pain not adequately managed with alternative treatments.</p> Signup and view all the answers

Which of the following are adverse effects of opioid agonists/antagonists?

<p>Hallucinations (A), Constipation (B), Headache (C), Dizziness (D), Nausea and/or vomiting (E), Vertigo (F), Drowsiness (H), Euphoria (I)</p> Signup and view all the answers

What is the ceiling effect in relation to opioid agonists/antagonists?

<p>Opioid agonists/antagonists have a ceiling effect on respiratory depressant action.</p> Signup and view all the answers

What is naloxone?

<p>Prototype opioid antagonist that rapidly reverses opioid-induced CNS and respiratory depression.</p> Signup and view all the answers

What are the therapeutic effects of naloxone?

<p>Subcutaneous: 2 to 5 minutes (A), IV: about 2 minutes (B), Intranasal: 8 to 13 minutes (C), IM: 2 to 5 minutes (D)</p> Signup and view all the answers

How does naloxone work?

<p>Competes with opioids for receptor sites in the brain, preventing binding or displacing opioids.</p> Signup and view all the answers

Which of the following are adverse effects of naloxone?

<p>Sweating (A), Hypertension (C), Drowsiness (D), Nausea and vomiting (E), Decreased respirations (F), Tremors (G)</p> Signup and view all the answers

Which of the following are contraindications for naloxone?

<p>Known hypersensitivity to the drug (A), Presence of narcotic misuse (B)</p> Signup and view all the answers

Which of the following are special populations to consider for naloxone use?

<p>Abnormal kidney function (A), Hepatic impairment (B), Older adults (C), Critical illnesses (D), Children (E), Home care (G)</p> Signup and view all the answers

What is the primary function of diuretics?

<p>Diuretics increase urine formation and output.</p> Signup and view all the answers

Which of the following conditions are considered edematous conditions?

<p>Heart failure (A), Kidney disease (C)</p> Signup and view all the answers

The nephron is the functional unit of the kidney.

<p>True (A)</p> Signup and view all the answers

What are the three main processes involved in urine formation?

<p>Tubular secretion (B), Glomerular filtration (C), Tubular reabsorption (D)</p> Signup and view all the answers

What is the primary site of action for loop diuretics?

<p>Loop of Henle.</p> Signup and view all the answers

What is the primary site of action for thiazide diuretics?

<p>Distal tubule.</p> Signup and view all the answers

Potassium-sparing diuretics like spironolactone conserve potassium.

<p>True (A)</p> Signup and view all the answers

What is the mechanism of action for osmotic diuretics like mannitol?

<p>Osmotic diuretics increase the osmolarity in the nephron, leading to increased water excretion.</p> Signup and view all the answers

What is the daily minimum urine output recommended for a healthy individual?

<p>At least 400 mL.</p> Signup and view all the answers

Hypokalemia can lead to cardiotoxicity.

<p>True (A)</p> Signup and view all the answers

What are two ways to prevent hypokalemia when using diuretics?

<p>Use potassium-sparing diuretics and potassium supplements.</p> Signup and view all the answers

Hyperkalemia is an excess of potassium levels.

<p>True (A)</p> Signup and view all the answers

How can hyperkalemia be managed?

<p>Avoid potassium supplements (A), Maintain adequate urine output (B)</p> Signup and view all the answers

What is the goal of fluid mobilization in diuretic therapy?

<p>Fluid mobilization aims to decrease plasma volume, which can reduce edema.</p> Signup and view all the answers

What factors should be considered when selecting a diuretic?

<p>The patient's condition and the desired diuretic effect.</p> Signup and view all the answers

What are combination products in diuretic therapy?

<p>Diuretics combined with antihypertensives (B)</p> Signup and view all the answers

Define edema.

<p>Edema is excessive fluid accumulation in body tissues.</p> Signup and view all the answers

What are some examples of special populations that require careful diuretic use?

<p>Children and older adults.</p> Signup and view all the answers

What are renal function alterations?

<p>Renal function alterations affect the kidney's ability to filter and excrete substances.</p> Signup and view all the answers

What are corticosteroids?

<p>Hormones from the adrenal cortex that affect body organs.</p> Signup and view all the answers

What is homeostasis?

<p>Balance maintained by normal corticosteroid secretion.</p> Signup and view all the answers

What are exogenous corticosteroids?

<p>Medications derived from corticosteroids.</p> Signup and view all the answers

What are glucocorticoids?

<p>Corticosteroids involved in metabolism and inflammation.</p> Signup and view all the answers

What are mineralocorticoids?

<p>They control fluid and electrolyte balance.</p> Signup and view all the answers

What is the main mineralocorticoid?

<p>Aldosterone</p> Signup and view all the answers

What are adrenal sex hormones?

<p>Hormones affecting secondary sexual characteristics.</p> Signup and view all the answers

What are androgens?

<p>Male hormones increasing muscle mass and strength.</p> Signup and view all the answers

How is corticosteroid secretion controlled?

<p>By the hypothalamus and pituitary gland.</p> Signup and view all the answers

What is a negative feedback system?

<p>It regulates hormone secretion based on body needs.</p> Signup and view all the answers

What is therapeutic corticosteroid use?

<p>Large doses for new physiological effects.</p> Signup and view all the answers

What are anti-inflammatory effects of corticosteroids?

<p>Reduction of inflammation by glucocorticoids.</p> Signup and view all the answers

What are immunosuppressive effects of corticosteroids?

<p>Suppression of immune response by corticosteroids.</p> Signup and view all the answers

What is palliative therapy?

<p>Symptom relief without curing underlying condition.</p> Signup and view all the answers

What are drug selection factors for using corticosteroids?

<p>Consider purpose, characteristics, and patient needs.</p> Signup and view all the answers

What are dosing guidelines for corticosteroids?

<p>Smallest effective dose for shortest time.</p> Signup and view all the answers

What is local administration of corticosteroids?

<p>Targeted delivery to minimize systemic effects.</p> Signup and view all the answers

What is alternate-day therapy for corticosteroids?

<p>Double dose every other day to reduce side effects.</p> Signup and view all the answers

What is chronic condition management with corticosteroids?

<p>Tapered doses for ongoing treatment.</p> Signup and view all the answers

What are contraindications for corticosteroid use?

<p>Conditions where corticosteroids should be avoided.</p> Signup and view all the answers

Why are systemic fungal infections a contraindication for corticosteroid use?

<p>Corticosteroids are contraindicated due to infection risk.</p> Signup and view all the answers

Why is the frequency of corticosteroid administration important?

<p>It is important for minimizing adverse effects.</p> Signup and view all the answers

What is a major risk of long-term high-dose corticosteroid therapy?

<p>Adrenocortical function loss.</p> Signup and view all the answers

What are special populations to consider for corticosteroid use?

<p>Considerations for children and older adults.</p> Signup and view all the answers

What are corticosteroid receptors?

<p>They bind to target tissues influencing gene transcription.</p> Signup and view all the answers

What are physiologic effects of corticosteroids?

<p>Normal functions maintained by small corticosteroid doses.</p> Signup and view all the answers

Corticosteroids are only used to treat inflammatory conditions.

<p>False (B)</p> Signup and view all the answers

Local administration of corticosteroids is preferred because it minimizes systemic effects.

<p>True (A)</p> Signup and view all the answers

What is the main function of aldosterone?

<p>Regulation of salt and water balance (A)</p> Signup and view all the answers

Which of the following is NOT a risk associated with long-term high-dose corticosteroid therapy?

<p>Weight loss (E)</p> Signup and view all the answers

Which of the following is an example of a local corticosteroid administration method?

<p>Topical creams (B)</p> Signup and view all the answers

Flashcards

Tuberculosis

Infectious disease primarily affecting lungs and other organs.

Mycobacterium avium Complex (MAC)

Pathogenic mycobacteria found in water and soil.

Latent Tuberculosis Infection (LTBI)

Inactive TB infection without symptoms or disease.

Active Tuberculosis

Symptomatic TB infection requiring treatment.

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Drug-Resistant Tuberculosis

TB strains resistant to standard anti-TB drugs.

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Multidrug-Resistant Tuberculosis (MDR-TB)

Resistant to most effective anti-TB medications.

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Extensively Drug-Resistant TB (XDR-TB)

Resistant to second-line anti-TB medications.

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Transmission

Spread of TB through inhalation of droplets.

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Primary Infection

Initial stage of TB after exposure.

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Public Health Concern

MDR-TB poses significant risks to communities.

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Directly Observed Therapy (DOT)

Healthcare provider observes medication ingestion.

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Sputum Cultures

Tests to detect TB bacteria in respiratory samples.

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Signs of Active TB

Persistent cough, fever, weight loss, night sweats.

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Drug Therapy Goals

Cure infection, prevent drug resistance, minimize transmission.

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Adherence to Therapy

Critical for effective TB treatment outcomes.

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Immunosuppression

Increased susceptibility to TB infections.

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CDC Recommendations

Guidelines for TB control and treatment.

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Nurses' Role

Educate, administer medications, track contacts.

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Treatment Duration

Minimum of 6 months for active TB.

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Drug Therapy Monitoring

Regular assessments for adverse effects and compliance.

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Risk Factors for TB

Immigration, immunosuppression, and crowded living conditions.

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HIV and TB

HIV increases risk of developing active TB.

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Diagnostic Challenges

Delayed diagnosis contributes to drug resistance.

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First-Line Agents

Primary medications for treating TB infections.

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Second-Line Medications

Used when first-line drugs are ineffective.

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Global TB Statistics

1.5 million deaths from TB in 2020.

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TB Control Strategies

Educate and support patients for treatment adherence.

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Pharmacokinetics

The study of how the body processes a drug: absorption, distribution, metabolism, and excretion.

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Macrolide Antibacterials

A class of antibiotics that includes erythromycin, azithromycin, and clarithromycin.

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Erythromycin

Prototype macrolide with broad tissue distribution.

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Bacteriostatic

Inhibits bacterial growth without killing them.

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Bactericidal

Kills bacteria, depending on the concentration.

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Gram(+) cocci

Effective against positive cocci bacteria.

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Hepatic impairment

Liver dysfunction affecting drug metabolism.

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Critical illness

Severe health condition impacting drug efficacy.

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Adverse effects

Unwanted reactions from medication use.

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Contraindications

Conditions preventing safe drug use.

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Azithromycin

Macrolide used for various infections.

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Clarithromycin

Macrolide effective against respiratory infections.

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Fidaxomicin

Macrolide primarily for C. difficile infections.

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Rifaximin

Miscellaneous anti-infective for gastrointestinal infections.

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Tedizolid

Oxazolidinone effective against resistant bacteria.

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Telavancin

Lipoglycopeptide for skin and soft tissue infections.

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Tigecycline

Glycylcycline for multi-drug resistant infections.

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Vancomycin

Glycopeptide antibiotic for serious infections.

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Culture and susceptibility reports

Tests to identify bacterial resistance.

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Narrow spectra of activity

Limited range of effective bacteria.

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Patient teaching

Educating patients on medication use and effects.

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Aminoglycosides

Treat serious gram(−) infections, poorly absorbed orally.

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Gentamicin

Prototype aminoglycoside antibiotic.

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Fluoroquinolones

Synthetic drugs, effective against gram(−) and gram(+) organisms.

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Ciprofloxacin

Prototype fluoroquinolone antibiotic.

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Bactericidal agents

Kill bacteria rather than inhibit growth.

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Poor GI absorption

Aminoglycosides are poorly absorbed from the gastrointestinal tract.

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Parenteral administration

Delivers drugs via injection for wider distribution.

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Nephrotoxicity

Kidney damage due to high aminoglycoside concentrations.

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Ototoxicity

Hearing loss from aminoglycoside accumulation in the inner ear.

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Excretion of aminoglycosides

Excreted unchanged in urine, not metabolized.

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Mechanism of action

Inhibit bacterial protein synthesis by penetrating cell walls.

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Indications for use

Serious infections like septicemia and meningitis.

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Fluoroquinolone metabolism

Metabolized mainly in kidneys and liver.

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Bacterial DNA enzyme synthesis

Fluoroquinolones interfere with this process for bacterial growth.

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Indications for fluoroquinolones

Treat infections in respiratory, genitourinary, and gastrointestinal tracts.

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Contraindications for fluoroquinolones

Include hypersensitivity and use in children under 18.

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Drug selection

Based on specific organism causing the infection.

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Aminoglycoside dosing

Monitored based on serum concentration, peak and trough.

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Adverse effects monitoring

Identify high-risk patients and detect issues early.

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Hydration in therapy

Keep patients well-hydrated to reduce toxicity.

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Special populations

Includes children, older adults, and patients with kidney issues.

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Reducing toxicity guidelines

Limit aminoglycoside use to 10 days unless necessary.

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Beta-Lactam Ring

Chemical structure essential for antibacterial activity.

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Antibacterial Activity

Effectiveness against bacterial infections.

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Penicillins

First developed antibiotics, effective against gram(+) bacteria.

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Cephalosporins

Broad-spectrum antibiotics derived from fungi.

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Carbapenems

Effective against resistant gram(−) bacteria.

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Monobactams

Active against gram(−) bacteria, minimal side effects.

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Beta-Lactamase Inhibitors

Protect penicillins from destruction by enzymes.

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Cross-Allergenicity

Potential allergic reaction to related antibiotics.

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Extended-Spectrum Penicillins

Effective against gram(−) organisms, available orally.

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Clinical Indications

Used for surgical prophylaxis and various infections.

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Contraindications for Penicillins

Allergic reactions and cross-sensitivity with cephalosporins.

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Therapeutic Concentrations

Effective drug levels in body fluids.

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Intraocular Concentration

Drug levels in the eye, often low.

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Rapid Excretion

Quick elimination from the body via kidneys.

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Resistance Incidence

Increasing resistance to beta-lactam antibiotics.

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Surgical Prophylaxis

Preventive antibiotic use during surgery.

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Septicemia

Blood infection requiring aggressive antibiotic treatment.

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Home Care

Antibiotic therapy management outside hospital settings.

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Drug Selection Principles

Based on infection severity and causative organism.

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Pain

An unpleasant, uncomfortable sensation that usually indicates tissue damage.

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Opioid analgesics

Drugs that provide pain relief by affecting people's perception and tolerance of moderate to severe pain.

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Etiology of Pain

Causes of pain include nerve damage, tissue injury, cancer, and surgery.

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Pathophysiology of Pain #1

Tissue damage activates pain receptors in peripheral nerves.

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Nociceptors

Pain receptors in peripheral nerves that are activated by tissue damage.

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Pathophysiology of Pain #2

To feel pain, signals must travel from nociceptors in peripheral tissue to the spinal cord and then to the brain.

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Endogenous Analgesia

CNS's own system for relieving pain by suppressing pain signals from peripheral nerves.

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SOCRATES

Self-reporting is the gold standard of pain assessment measurement affected by mood, sleep disturbances, fatigue, medications, culture, gender, age, and other psychosocial factors.

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Preventive analgesia

Opioid analgesics inhibit adenylate cyclase, reduce perception of pain sensations in the brain, decrease emotional upset, and inhibit production of pain and inflammation.

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Morphine sulfate

Prototype opioid analgesic used mainly to relieve acute or chronic moderate to severe pain.

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Patient-controlled analgesia (PCA)

A method of pain management that allows patients to control their pain relief.

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Duration of action of Morphine

5 to 7 hours for morphine sulfate.

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Administration routes of Morphine

Morphine sulfate is well absorbed after oral (PO), intramuscular (IM), subcutaneous, and intravenous (IV) administration.

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Tolerance

A condition that develops with the use of opioid analgesics, requiring higher doses to achieve the same effect.

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Subgroups of opioids

Include opioid agonists, agonists/antagonists, and antagonists.

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Measurement tools for pain

Include visual analog scales, verbal or numerical rating scales, and picture scales.

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Opioid Agonists

Binds to receptors to block transmission of pain impulses.

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Major types of opioid receptors

Mu, kappa, and delta.

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Effects of Opioid Agonists

Analgesia, CNS depression, respiratory depression, sedation, euphoria, decreased gastrointestinal motility, and physical dependence.

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Use of Opioid Agonists

Prevent or relieve moderate to severe acute or chronic pain.

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Conditions for Opioid Use

Acute MI, biliary or renal colic, burns, other traumatic injuries, postoperative states, and cancer.

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Indications for Opioid Use

Pre- and postoperative sedation, decreased anxiety, facilitates anesthesia induction, and decreases amount of anesthesia needed.

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Labor and delivery

Indication for opioid use.

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Treatment of acute pulmonary edema

Indication for opioid use.

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Treatment of GI disorders

Indication for opioid use including abdominal cramping and diarrhea.

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Treatment of severe, unproductive cough

Indication for opioid use.

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Contraindications for Opioid Use

Hypersensitivity to opioids, existing respiratory depression, acute or chronic lung disease, upper airway obstruction, concurrent use of MAOs, and pregnancy.

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Cautions for Opioid Use

Use cautiously with hypotension, thyroid dysfunction, liver or kidney disease, increased intracranial pressure and head injury, seizure disorder, severe alcoholism, and benzodiazepines or other CNS depressants.

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Schedule II drugs

Most opioid analgesics are Schedule II drugs because they may lead to drug abuse or dependence.

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What are diuretics?

Medications that increase urine formation and output.

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What are edematous conditions?

Conditions like heart failure and kidney disease that cause fluid retention in the body.

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What are nonedematous conditions?

Conditions like hypertension that don't primarily cause fluid retention.

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What is a nephron?

The functional unit of the kidney, composed of the glomerulus and tubule.

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What is glomerular filtration?

The process of filtering blood in the nephron.

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What is tubular reabsorption?

The process of reclaiming water and solutes from the filtrate.

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What is tubular secretion?

The process of adding substances to the filtrate.

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What are loop diuretics?

Diuretics that act on the loop of Henle in the kidney, like furosemide.

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What are thiazides?

Diuretics that act on the distal tubule in the kidney, like hydrochlorothiazide.

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What are potassium-sparing diuretics?

Diuretics that conserve potassium, like spironolactone.

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What are osmotic diuretics?

Diuretics that increase the osmolarity in the nephron, like mannitol.

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What is the daily minimum urine output?

The minimum amount of urine a person should produce daily to remove metabolic waste.

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What is cardiotoxicity of hypokalemia?

Low potassium levels can negatively affect the heart.

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How can you prevent hypokalemia?

This involves using potassium-sparing diuretics and potassium supplements.

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What is hyperkalemia?

Excess potassium levels that can be harmful to the heart.

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How can you manage hyperkalemia?

This involves avoiding potassium supplements and maintaining sufficient urine output.

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What is fluid mobilization?

Decreasing plasma volume to reduce the amount of fluid buildup in the body.

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What is drug selection in diuretic therapy?

The choice of diuretic depends on the patient's condition and the desired effect.

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What are combination products in diuretic therapy?

Fixed-dose combinations of diuretics with antihypertensives.

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What is edema?

Excessive fluid accumulation in body tissues.

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What are special populations in diuretic therapy?

Groups like children and older adults who require special considerations when using diuretics.

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What are renal function alterations?

Conditions that affect the kidney's ability to filter and excrete waste products.

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What is diuresis?

The process of eliminating excess fluid from the body.

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What are hypokalemic diuretics?

Diuretics that can cause an electrolyte imbalance, particularly a decrease in potassium levels.

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What are uricosuric diuretics?

These drugs can cause a build-up of uric acid in the body, potentially leading to gout.

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What is diuretic therapy?

The use of diuretics to relieve fluid overload and associated symptoms.

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What is a diuretic?

A substance that causes the body to eliminate more fluid, especially through urine.

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What is prophylactic diuretic therapy?

The use of diuretics to prevent the development of fluid overload.

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Corticosteroids

Hormones produced by the adrenal cortex that influence various bodily functions.

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Homeostasis

The state of balance maintained by the body's normal production of corticosteroids.

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Exogenous corticosteroids

Medications synthesized from corticosteroids to mimic their effects.

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Glucocorticoids

Type of corticosteroid involved in metabolism and controlling inflammation.

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Mineralocorticoids

Type of corticosteroid that regulates electrolyte balance and fluid levels.

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Aldosterone

The primary mineralocorticoid that regulates salt and water balance.

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Adrenal sex hormones

Hormones produced by the adrenal cortex that influence secondary sexual characteristics.

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Androgens

Male hormones responsible for muscle mass and strength.

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Estrogens

Female hormones with limited physiological effects in males.

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Corticosteroid secretion

The process of producing corticosteroids, controlled by the hypothalamus and pituitary gland.

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Negative feedback system

A system where hormone secretion is regulated based on the body's needs.

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Therapeutic corticosteroid use

Using corticosteroids in high doses to achieve specific physiological effects.

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Anti-inflammatory effects

The ability of glucocorticoids to reduce inflammation.

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Immunosuppressive effects

The ability of corticosteroids to suppress the immune response.

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Palliative therapy

Treatment aimed at relieving symptoms without curing the underlying condition.

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Drug selection factors

Factors like the purpose of treatment, medication characteristics, and patient needs that guide medication choice.

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Dosing guidelines

Guidelines that aim for the smallest effective dose for the shortest duration.

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Local administration

Delivering medication directly to the target area to minimize systemic effects.

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Alternate-day therapy

A strategy where a double dose is given every other day, reducing side effects.

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Acute administration

Using high doses for a short period to treat a condition.

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Chronic condition management

Using tapered doses over a longer period to manage an ongoing condition.

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Systemic fungal infections

Corticosteroids are contraindicated due to the risk of worsening infection.

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Frequency of administration

The frequency of medication administration is important to minimize adverse effects.

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Adrenocortical function loss

A major risk associated with long-term high-dose corticosteroid therapy.

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Corticosteroid receptors

Specialized proteins in the body that corticosteroids bind to, influencing gene activity.

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Physiologic effects

The normal functions maintained by small doses of corticosteroids.

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Study Notes

Tuberculosis (TB) Overview

  • TB is an infectious disease affecting lungs and other organs.
  • Latent TB infection (LTBI) is an inactive form without symptoms.
  • Active TB is symptomatic and requires treatment.
  • Drug-resistant TB is a serious complication, including MDR-TB (multidrug-resistant) and XDR-TB (extensively drug-resistant).
  • TB transmission occurs through inhalation of droplets.

Mycobacterium avium Complex (MAC)

  • MAC is a pathogenic mycobacteria found in water and soil.

Drug Resistance in Tuberculosis

  • MDR-TB is resistant to most first-line anti-TB drugs.
  • XDR-TB is resistant to both first-line and many second-line anti-TB drugs.
  • Drug resistance poses a major public health risk.
  • Culture and susceptibility reports are used to identify bacterial resistance to drugs.

Aminoglycoside and Fluoroquinolone Therapy

  • Aminoglycosides treat serious gram-negative infections; poorly absorbed orally.
  • Gentamicin is a prototype aminoglycoside antibiotic.
  • Fluoroquinolones are synthetic drugs effective against gram-negative and gram-positive organisms.
  • Ciprofloxacin is a prototype fluoroquinolone antibiotic.
  • Bactericidal agents kill bacteria; bacteriostatic agents only inhibit growth.
  • Aminoglycosides have poor gastrointestinal absorption.
  • Parenteral administration (injection) provides wider distribution.
  • Nephrotoxicity (kidney damage) and ototoxicity (hearing loss) are potential aminoglycoside side effects.
  • Aminoglycosides are excreted unchanged in the urine; not metabolized.
  • Aminoglycosides inhibit bacterial protein synthesis by penetrating cell walls.
  • Indications include serious infections like septicemia and meningitis.
  • Fluoroquinolone metabolism occurs mainly in the kidneys and liver.
  • Fluoroquinolones interfere with bacterial DNA enzyme synthesis.
  • Fluoroquinolones treat respiratory, genitourinary, and gastrointestinal infections.
  • Contraindications include hypersensitivity and use in those under 18.
  • Drug selection is based on the causative organism.
  • Aminoglycoside dosing is monitored by serum concentration (peak and trough).
  • Adverse effect monitoring is crucial for early detection.
  • Hydration reduces aminoglycoside toxicity.
  • Patient education is key for understanding medication effects and adverse reactions.
  • Special populations (children, seniors, those with kidney issues) require careful consideration.
  • Limiting aminoglycoside use to 10 days (unless necessary) can reduce toxicity.

Beta-Lactam Antibacterial Agents

  • Beta-lactam ring is crucial for antibacterial action.
  • Antibacterial activity is the measure of effectiveness against bacterial infections.
  • Penicillins, the first antibiotics, work primarily on gram-positive bacteria.
  • Cephalosporins, derived from fungi, are broader-spectrum antibiotics than penicillins.
  • Carbapenems are useful against resistant gram-negative bacteria.
  • Monobactams target gram-negative bacteria with minimal side effects.
  • Their mechanism of action involves inhibiting bacterial cell wall synthesis.
  • Beta-lactamase inhibitors protect penicillins from enzymatic destruction.
  • Cross-allergenicity is the risk of allergic reactions to related antibiotics.
  • Extended-spectrum penicillins effectively treat gram-negative bacterial infections orally.
  • Beta-lactam antibiotics have various clinical indications, including surgical prophylaxis and treating various infections.
  • Contraindications include allergies and cross-sensitivity with cephalosporins.
  • Beta-lactams are bactericidal, causing bacterial death.
  • Effective drug levels (therapeutic concentrations) are crucial for clinical success.
  • Intraocular concentrations of some beta-lactams may be low.
  • These antibiotics are rapidly excreted via the kidneys.
  • Resistance to beta-lactam antibiotics is increasing.
  • Surgical prophylaxis involves using antibiotics before surgery for prevention.
  • Septicemia, a bloodstream infection, demands aggressive beta-lactam treatment.
  • Beta-lactam use requires careful consideration of special populations (children, elderly, and critically ill).
  • Home care practices are crucial for antibiotic administration outside hospitals.
  • Drug selection depends on infection severity and the causative organism.

Treatment and Management

  • Treatment goals include curing the infection, preventing resistance, and minimizing transmission.
  • Directly Observed Therapy (DOT) is critical, with healthcare providers observing medication intake.
  • Sputum cultures detect TB bacteria in samples.
  • Active TB signs include persistent cough, fever, weight loss, and night sweats.
  • Active TB treatment typically lasts a minimum of 6 months.
  • Adherence is essential for successful treatment.
  • Immunosuppression increases TB infection risk.
  • CDC recommendations guide TB control and treatment.
  • Patient teaching is crucial for medication use and effects.

Patient Care and Public Health

  • Nurses play a critical role in patient education, medication administration, and contact tracing.
  • Risk factors include immigration, immunosuppression, and crowded living conditions.
  • HIV significantly increases active TB risk.
  • Timely diagnosis is crucial to prevent drug resistance.
  • First-line agents are the initial TB treatment medications.
  • Second-line medications are used when first-line drugs fail.
  • Global TB statistics show high morbidity and mortality.
  • TB control strategies include educating and supporting patient adherence.
  • Regular monitoring of drug therapy is essential to identify and manage adverse effects and ensure patient compliance.
  • Anti-infective agents (macrolides, oxazolidinones, glycopeptides, glycylcyclines, and miscellaneous agents) include specific examples.
  • Some antibiotics are bacteriostatic (inhibit bacterial growth), while others are bactericidal (kill bacteria at a certain concentration).
  • Pharmacokinetic factors (absorption, distribution, metabolism, excretion) affect drug efficacy.
  • Hepatic impairment and critical illness can affect drug efficacy and metabolism.
  • Adverse effects and contraindications of the drugs need to be considered.
  • Antibiotic use varies based on targets. Some, like erythromycin, have a broad spectrum; others have a narrow spectrum, targeting specific bacteria types, like erythromycin against Gram (+) cocci.

Corticosteroids

  • Corticosteroids are hormones from the adrenal cortex affecting various body organs.
  • Homeostasis is the balance maintained by normal corticosteroid secretion.
  • Exogenous corticosteroids are medications derived from corticosteroids.
  • Glucocorticoids are corticosteroids involved in metabolism and inflammation.
  • Mineralocorticoids control fluid and electrolyte balance.
  • Aldosterone is the primary mineralocorticoid regulating salt and water balance.
  • Adrenal sex hormones affect secondary sexual characteristics.
  • Androgens are male hormones increasing muscle mass and strength.
  • Estrogens are female hormones with limited physiological effects.
  • Corticosteroid secretion is controlled by the hypothalamus and pituitary gland.
  • A negative feedback system regulates hormone secretion based on body needs.
  • Therapeutic corticosteroid use involves large doses for new physiological effects.
  • Anti-inflammatory effects reduce inflammation through glucocorticoids.
  • Immunosuppressive effects suppress the immune response by corticosteroids.
  • Palliative therapy relieves symptoms without curing the underlying condition.
  • Drug selection factors consider the purpose, characteristics, and patient needs.
  • Dosing guidelines emphasize the smallest effective dose for the shortest duration.
  • Local administration minimizes systemic effects to target delivery.
  • Alternate-day therapy reduces side effects by using double doses every other day.
  • Acute administration uses large doses for short-term treatment.
  • Chronic condition management involves tapered doses for ongoing treatment.
  • Contraindications are conditions where corticosteroids should be avoided.
  • Systemic fungal infections are a contraindication due to infection risk.
  • Frequency of administration is important for minimizing adverse effects.
  • Adrenocortical function loss is a potential major risk with long-term high-dose therapy.
  • Special populations including children and older adults need tailored considerations.
  • Corticosteroid receptors bind to target tissues impacting gene transcription.
  • Physiologic effects are maintained by small doses of corticosteroids to maintain normal functions.

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