1. Week 3 Introduction

2. Week 3 Seminar Chapter 7 &18 Measurement Systems and Their Equivalents and Antimicrobials/Antifungals/Antivirals 2

3. Assignment Hints  Show your work, so I can give partial credit  Don’t forget about the Math Center if you need help 3

4. Three Basic Units of Measurement  Volume – liter (L)  Length – meter (m)  Weight – gram (g, gm) 4

5. Sliding Mnemonic Conversions Kilo hecto deka METER(m) deci centi milli * * micro(µ) LITER(L) GRAM(g) 10 -3 10 -2 10 -1 > 10 1 10 2 10 3 * * 10 6 EX:. 0045kg 4,500mg = 4,500,000mcg ( µ) EX:.075km 7500cm =75,000mm

6. Meter the metric unit of Length =1,000,000micrometers 1 Meter = 1,000 millimeter = 100 centimeters =10 decimeters =0.1 dekameters =0.01 hectometers =0.001 kilometers 6

7. Length Measurement 1 Meter = 39.37 inches 2.5 cm = 1 inch 1 m = 1000 mm 1 m = 100 cm 1 cm = 10 mm 7

8. Length Mneumonic Method  75mm=___cm  K h d d c m * * µ  Start @ milli, must move decimal to the left one time to reach centi so move 75 mm to 7.5 cm

9. Length Conversion Factors  Divide if smaller unit is given and larger unit must be found  Moving decimal left = divide Example: ________cm = 75 mm (smaller unit) 75 ÷ 10 = 7.5 75 mm = 7.5 cm Rule: 1 cm = 10 mm 9

10. Length Conversion Factors  Multiply if larger unit is given and smaller unit must be found  Moving decimal right = multiply Example: ________mm = 2.5 m (larger unit) 2.5 x 1000 = 2500 2.5 m = 2500 mm Rule: 1000 mm = 1 m page 133 10

11. Length Alternate Way  75mm =____ cm  Remember 1cm = 10mm from page 133  75mm x 1cm or 75mm x 1cm 10mm10mm  mm cross each other out leaving cm  75/10= 7.5cm 11

12. Length Mneumonic method  2.5m=____mm  K h d d c m * * µ  Start @ meter (base) and move 3 decimal points to the right so 2.5m becomes 2500mm

13. Length Conversion Factors  Multiply if larger unit is given and smaller unit must be found  Moving decimal right = multiply Example: ________mm =3.6 m (larger unit) Who can solve this? 13

14. Length Alternate Way  2.5m = mm  1m = 1000mm (from page 133)  2.5m x 1000mm or 2.5m x 1000mm 1m  The m cross each other out leaving mm  2.5 x 1000=2500mm 14

15. Length Mneumonic Method  3.6m=____mm  K h d d c m * * µ  Start @ meter (base) move 3 decimal spaces to the right so 3.6m becomes 3600mm’s

16. Length Conversion Factors  Multiply if larger unit is given and smaller unit must be found  Moving decimal right = multiply Example: ________mm =3.6 m (larger unit) 3.6 x 1000 = 3600 3600 mm = 3.6 m 16

17. Length Alternate Way  3.6 m = mm  Again 1m = 1000mm  3.6m x 1000mm/1m or  3.6m x 1000mm 1m  The m cross each other out leaving  3.6 x 1000mm= 3600mm 17

18. Metric Measure of Weight Gram =1,000,000micrograms  1 gram= 1000 mg = 100 centigrams = 10 decigrams = 0.1 dekagram = 0.01 hectogram = 0.001 kilogram 18

19. Most Commonly Used  Milligram  Gram  Kilogram  1000mg (mg)=1 gram (g) ***  1000gms (g)= 1 kilogram (kg. or kilo) 19

20. Weight Measurement 1 kg = 2.2 pounds *** 1 kg = 1000 g 1 mg = 0.001g 1 mg = 1000 mcg or µg 20

21. Weight Conversion Factors Alternate Way _____ mg = 8 g(larger unit) 8 X 1000 = 8000 mg 8000 mg = 8 g Rule: 1000 mg = 1 g _____ mg = 635 mcg (smaller unit) 635 ÷ 1000 = 0.635 mg 0.635 mg = 635 mcg Rule: 1 mg = 1000 mcg or µg 21

22. Weight Alternate Way _____ mg = 8 g Remember 1g = 1000mg Page 136 8g x 1000mg/1g or 8g x 1000mg 1g g cross each other out 8 x 1000= 8000mg _____ mg = 635 mcg  1mg =1000mcg Page 136  635mcg x 1mg/1000mcg or 635mcg x 1mg 1000mcg  mcg cross each other out  635/1000= 0.635mcg 22

23. Weight Mneumonic Method  8g=____mg  K h d d c m * * µ  Start @ gram (base) and move 3 units to the right to get milligrams  8g to the right becomes 8000mg  635mcg( µ )=___ _mg  K h d d c m * * µ  Start @ mcg(µ) and move 3 units to the left to reach milligrams  635mcg to the left becomes 0.635mg

24. WHO CAN SOLVE THIS? _____ mcg = 0.3 mg (larger unit) 24

25. Answer  0.3mg = mcg  Remember 1mg = 1000mcg (page 136)  0.3mg x 1000mcg 1mg  mg cross each other out leaving mcg  0.3 x 1000 = 300mcg >>OR<<  K h d d c m * * µ  Start @ mg, move three to the right for mcg’s  0.3mg = 300mcg 25

26. Household System **Important**  Volume 1 cup (c) = 8 oz 1 pint (pt) = 2 c = 16 oz 1 quart (qt) = 2 pt = 4 c =32 oz 1 gallon (gal)= 4 qt= 8 pt = 16c = 128oz  Weight or mass 1 pound = 16 oz  Length 1 foot = 12 in 1 yard = 3ft 36in 26

27. Units Measured according to strength and desired effect heparin insulin penicillin G vitamins A,D,E 27

28. Review  Remember 1kg=2.2lbs  How much will a 160lb person weigh in kilograms? 28

29. Answer  160lbs x 1kg = 72.7kg 2.2lbs The pounds cancel each other leaving kg. 29

30. Review  One teaspoon is how many mls? 30

31. Answer  5mls 31

32. Book Review  Length Conversion Review Page 134 7-2 Example 5.5m to mm  Volume Conversion review Page 136 7-3 Example 500ml to L  Weight Conversion Page 137 7-4 Example 1500mcg to mg 32

33. Questions 33

34. ANTIBIOTICS 34 Drug Classes

35. Chapter 18 35  Antibiotic is anti + Greek bios, life so against life.  Produced from natural substances including molds and bacteria.  Inhibit growth or kill other microorganisms.  There are families of antibiotics all similar to the original chemical, with various prosperities that make them useful for treating different types of infections.

36. When choosing an Antibiotic 36  Want maximum effect with minimal harm to patient.  Match bug to drug, if possible  What is the organism, what drugs is it sensitive to, and the host factors at the site. Also health status of the patient including immune status.

37. Antibiotic Resistance 37  The main reason for the development of drug-resistant microbes is the inappropriate use of antibiotics.  The more an antibiotic is used the faster drug resistance develops.  Improper prescribing by health care workers and patients not finishing the course of therapy contribute.  No excuse for casual or indiscriminate use of antibiotics.

38. Penicillin's 38 First of true antibiotics –introduced in 1940’s Remain the most effective and least toxic of available antimicrobials. Changes in the chemical structure of the penicillins over the years have increased their usefulness and effectiveness in controlling disease. Most generic names for penicillins end in–cillin while many trade names have pen in their names  Example:penicillin V-generic, Pen-VEE-K- trade -tabs, Bicillin LA/Pen-G IM

39. How Penicillin's are Classified 39  Narrow-spectrum First generation-Penicillin  Narrow-spectrum antistaphylococcal -Dicloxacillin Used on drug resistant staphylococci strains  Broad-Spectrum Second generation- Ampicillin, Amoxil Effective against a broader spectrum  Extended-spectrum Third generation-Piperacillin Wider antimicrobial action than second

40. Side Effects of Penicillins 40  Nausea and Vomiting; as with all antibiotics  Allergic reactions-rashes and hives  Tend to precipitate more severe allergic reactions than other medications  Patients should report diarrhea, sore mouth and tongue, hives and or itching may be due to allergy.  A patient allergic to one should be considered allergic to all  Always ask about allergies esp. penicillin.

41. Cephalosporins 41  Structurally related to the penicillins  Active against a broad spectrum of pathogens  Classified in four generation 1 st generation cephalosporin  Active against gram positive bacteria Ex, Keflex, ancef, and duricef 2 nd generation cephalosporin  Increased effectiveness against gram negative  Ex. Ceclor, Ceftin and mefoxin 3 rd and 4 th generation  Not as effective against gram positive cocci  Rocephin, Omnicef, Fortaz

42. Tetracyclines (suffix “cycline”) 42  First group of broad-spectrum antibiotics  Long Acting : Doxycycline, minocycline  Short Acting : Tetracycline  Do not give with dairy products or antacids. Can decrease effectiveness  Harmful if used after the expiration date.  Side effects Sun sensitivity Stains developing teeth, don’t use in children less than 8 yrs. Broad spectrum can cause super-infection

43. Macrolide Antibiotics  “ ACE”=Azithromycin(Z-pak), Clarithromycin (Biaxin), Erythromycin  Useful in treating atypical infections (ex: chlamydia, legionnaire’s, atypical pneumonia, Lymes disease)  Can be used when patient is penicillin allergic *1 st line alternative*  Similar spectrum of activity as penicillins, with added atypical coverage  SE’s: GI symptoms, headaches

44. Other Abx  Floroquinolones (Cipro, Levaquin)  Vancomycin: Toxic drug reserved for treating serious infections (MRSA, C. dif) in patients allergic to penicillin

45. Sulfonamides (Sulfa Drugs)  Antibacterials slow growth of bacteria while body builds its own defenses  Primarily treat urinary tract infections, in combination therapy for otitis media  Take oral sulfonamides with full glass of water on empty stomach

46. Sulfonamides (Sulfa Drugs)  May cause photosensitivity reactions  Urine should be acidic for optimum effectiveness  Take medications for urinary tract infections for 2 weeks to prevent development of more resistant infections  Topical preparations available in ocular forms, lotions, powders, ointments

47. Common Sulfonamides (Sulfa Drugs)  Gantrisin  Gantanol  Azulfidine  Triple Sulfa  Bactrim  Septra  Sulamyd  Silvadene cream

48. Viral Infections  Viruses—strands of genetic material wrapped in protein  Cannot sustain themselves independently; must rely on host  Difficult to suppress viral reproduction; host’s body cells would be harmed also

49. Drugs to treat Viral Infections  Drugs decrease symptoms, do not cure  Resistance to antiviral drugs major problem  Drug classifications: non-HIV infection medications HIV infection medications

50. Common Non- HIV Antiviral Drugs  Symmetrel and Flumadine—Influenza A  acyclovir (Zovirax)/ Valacyclovir (Valtrex) —herpes simplex, genital herpes, varicella zoster infections  ganciclovir— cytomegalovirus

51. HIV Antivirals  No cure for HIV  Dramatic advances in drug therapy  Health preserved, life prolonged  Multiple drug interactions and side effects  High cost, toxicity  Drug cocktail used; patient must adhere closely to prescribed dosage schedules  New drugs prescribed should be agents the patient has never taken

52. HIV Antivirals Medication  Medication Example Retrovir (AZT)- 1ST Norvir Ziagen Videx  Major Side effect Nephrotoxicity Diarrhea and headache Some cause Ocular toxicity  See the chart in Doc sharing

53. Case 1  75yo male in ER with Dx:Cellulitis to arm x3 days, Temp>103, Malaise  HX: HTN, DM and CHF  allergy : Keflex- Hive  Meds Toprol xl, Glucophage, Digoxin  ER-Md Orders : Zosyn(PCN) 3.375gm IVQ6h STAT  Good choice?

54. Week 3 Assignment & Discussion Board  Download the worksheet from Doc Sharing. (Week 3 Assignment.doc)  Complete the assignment in a Word document and submit through the Dropbox.  Write a prescription for one medication covered in Chapter 18: Antimicrobials, Antifungals and Antivirals **  Please put header with your name, class time

55. Discussion Board  Do not forget the discussion question for the week about Mrs. Smith calls the doctor’s office wanting a prescription for antibiotics. In your response address the following  Physician Concerns  Patient Concerns  Review CDC Guideline

56. Questions 56