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Chapter 4 Antibiotics © Paradigm Publishing, Inc.
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Pharmacology for Technicians, Fourth Edition
Chapter 4 Topics Fighting Bacterial Infections Major Classes of Antibiotic Drugs Storage of Liquid Antibiotics Ophthalmic Antibiotics Treating Complications of Infections © Paradigm Publishing, Inc. © Paradigm Publishing, Inc.
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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, and administration routes of major antibiotics. Use antibiotic and general drug terminology correctly in written and oral communication. © Paradigm Publishing, Inc.
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Fighting Bacterial Infections
Single-celled organisms occurring in most environments Infection Condition in which bacteria grow in body tissues and cause tissue damage by their presence or by toxins they produce © Paradigm Publishing, Inc.
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Types of Bacteria Aerobic Needs oxygen to survive Anaerobic Survives in the absence of oxygen © Paradigm Publishing, Inc.
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Bacteria Shapes (a) Round cocci (b) Rod-like bacilli (c) Spiral-shaped spirochetes © Paradigm Publishing, Inc.
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Gram Stain Gram-positive bacteria turn purple Gram-negative bacteria appear red © Paradigm Publishing, Inc.
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Gram Stain Results and Related Diseases
Shape Gram Stain Bacteria Related Disease rods gram-positive Corynebacteria endocarditis gram-negative E. Coli UTI © Paradigm Publishing, Inc.
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Gram Stain Results and Related Diseases
Shape Gram Stain Bacteria Related Disease cocci gram-positive Staphylococcus toxic shock syndrome gram-negative Neisseria Gonorrhea © Paradigm Publishing, Inc.
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Gram Stain Results and Related Diseases
Shape Gram Stain Bacteria Related Disease curved or spiral rods gram-negative Campylobacter septicemia spirochetes Treponema palladium syphilis © Paradigm Publishing, Inc.
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How Antibiotics Work Prevent folic acid synthesis Sulfonamides Inhibit cell wall formation Penicillins Cephalosporins © Paradigm Publishing, Inc.
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How Antibiotics Work Block protein formation Macrolides Tetracyclines Aminoglycosides Interfere with DNA formation Quinolones © Paradigm Publishing, Inc.
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How Antibiotics Work Disrupt cell membranes Cyclic lipopeptides Disrupt DNA structure Metronidazole © Paradigm Publishing, Inc.
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How Antibiotics Work Bactericidal Agent: Kills invading organisms Bacteriostatic Agent: Inhibits the growth or multiplication of bacteria © Paradigm Publishing, Inc.
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Antibiotic TX Ideal: Tx starts after a culture No time for Culture Tx with Broad-spectrum antibiotics © Paradigm Publishing, Inc.
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Dispensing Issues of Antibiotics
Warning! Mix exactly as directed by manufacturer Swab counting tray with alcohol between drugs to prevent cross-contamination © Paradigm Publishing, Inc.
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Side Effects of Antibiotics
Most antibiotics taken on an empty stomach to attain faster absorption Exceptions nitrofurantoin (Macrobid, Macrodantin) cefuroxime (Ceftin, Zinacef) © Paradigm Publishing, Inc.
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Antimicrobial Resistance
Developing largely because of Overuse Misuse Superinfection may occur Bacteria produce enzyme that destroys the molecular integrity of the drug © Paradigm Publishing, Inc.
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Antimicrobial Resistance
Pharmacy technician—place a label on antibiotics advising patient to take all of the medication © Paradigm Publishing, Inc.
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Terms to Remember bacteria infection aerobic anaerobic Gram staining © Paradigm Publishing, Inc.
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Terms to Remember bactericidal agent bacteriostatic agent superinfection © Paradigm Publishing, Inc.
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Discussion How might the widespread use of antibacterial soaps affect the population? Disinfectants not safe to use systemically © Paradigm Publishing, Inc.
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Major Classes of Antibiotic Drugs
Sulfonamides Pencillins Cephalosporins Tetracyclines and Tigecycline Macrolides Ketolides Quinolones Streptogramins Aminoglycosides Cyclic Lipopetides © Paradigm Publishing, Inc.
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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 © Paradigm Publishing, Inc.
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Allergy to Sulfonamides
If patient is allergic to sulfa, then drug of choice is nitrofurantoin (Macrobid, Macrodantin) © Paradigm Publishing, Inc.
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Therapeutic Uses of Sulfonamides
Urinary tract infections (UTIs) Otitis media Ulcerative colitis Lower respiratory infections Prophylaxis in Pneumocystis carinii pneumonia in immunocompromised © Paradigm Publishing, Inc.
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Side Effects of Sulfonamides
Rash Nausea Drug fever Vomiting Jaundice Kidney damage Blood complications Stevens-Johnson Syndrome: fatal marked by large red blotches on skin © Paradigm Publishing, Inc.
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Dispensing Issues of Sulfonamides
Avoid sun Maintain adequate fluid intake © Paradigm Publishing, Inc.
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Penicillins Low toxicity Kills bacteria by preventing them from forming rigid cell wall Because human cells do not have rigid cell walls, they are not affected © Paradigm Publishing, Inc.
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Therapeutic Uses of Penicillins
Abscesses Beta-hemolytic streptococcus Meningitis Otitis media Pneumonia © Paradigm Publishing, Inc.
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Therapeutic Uses of Penicillins
Respiratory infections Strep throat Tooth and gum infections Prophylaxis prior to dental procedures Sexually transmitted diseases (STDs; syphilis and gonorrhea) Endocarditis due to streptococci © Paradigm Publishing, Inc.
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Side Effects of Penicillins
Diarrhea Allergies in 7% to 10% of population © Paradigm Publishing, Inc.
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Dispensing Issues of Penicillins
Take on an empty stomach Food slows absorption Acids in fruit juices or colas could deactivate drug © Paradigm Publishing, Inc.
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Resistance to Penicillins
Penicillinase-resistant penicillins work against gram-positive aerobes Extended-spectrum penicillins are more resistant to gram-negative bacteria Penicillin combinations improve effect © Paradigm Publishing, Inc.
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Cephalosporins Mechanism of action similar to penicillins Person allergic to penicillin has about 1% chance of being allergic to cephalosporins © Paradigm Publishing, Inc.
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Dispensing Issues of Cephalosporins
Warning! Alert pharmacist if patient who is allergic to penicillin is receiving a cephalosporin Rx If patient wants cephalosporin dispensed, document communication in case of cross-reaction © Paradigm Publishing, Inc.
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First-Generation Cephalosporins
Similar to penicillinase-resistant penicillins but have greater gram-negative coverage Used for Community-acquired infections Mild to moderate infections © Paradigm Publishing, Inc.
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Second-Generation Cephalosporins
Increased activity, especially against Haemophilus influenzae Used for Otitis media in children Respiratory infections Urinary tract infections (UTIs) © Paradigm Publishing, Inc.
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Third-Generation Cephalosporins
Active against 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) © Paradigm Publishing, Inc.
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Fourth-Generation Cephalosporins
Broad-spectrum coverage, such as cefepime (Maxipime) Used for Pneumonia UTIs Sepsis IV form mixed in NS or D5W © Paradigm Publishing, Inc.
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Side Effects of Cephalosporins
Share side effects of penicillin A few may initiate unique toxic reactions Lower frequency of toxicity than many other antibiotics © Paradigm Publishing, Inc.
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Dispensing Issues of Cephalosporins
Warning! All cephalosporins look alike when written in the generic form Watch dosing and indications for use © Paradigm Publishing, Inc.
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Drugs Related to Penicillins and Cephalosporins
New beta-lactam drugs differ slightly in structure Carabpenems, carbacephems, and monobactam Some used for serious infections © Paradigm Publishing, Inc.
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Tetracyclines Broad-spectrum bacteriostatic antibiotics Inhibit protein synthesis in bacteria by binding to ribosomes Suppress infection, but require phagocytes to eradicate bacteria completely © Paradigm Publishing, Inc.
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Therapeutic Uses of Tetracyclines
Acne Anthrax Chronic bronchitis & pulmonary infections Lyme disease Mycoplasma pneumoniae infection Rickettsia infection Some sexually transmitted diseases, such as Chlamydia infection © Paradigm Publishing, Inc.
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Side Effects of Tetracyclines
Gastrointestinal upset with nausea and vomiting © Paradigm Publishing, Inc.
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Dispensing Issues of Tetracyclines
Avoid antacids to avoid chelation with minerals Photosensitization Pregnant women and children up to age 9 must avoid- teeth discoloration © Paradigm Publishing, Inc.
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Dispensing Issues of Tetracyclines
Warning! Expired drugs can be toxic, can cause fatal renal syndrome Pharmacy technician always watch the expiration date © Paradigm Publishing, Inc.
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Dispensing Issues of Tetracyclines
Warning! Government agencies stockpiling tetracyclines due to concern over terrorist attack Due to toxicity: must be rotated; destroy when out of date © Paradigm Publishing, Inc.
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Tigecycline New drug class: glycylcycline Similar to tetracyclines Used for Skin infections Intra-abdominal infections © Paradigm Publishing, Inc.
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Macrolides Inhibit protein synthesis by combining with ribosomes Used primarily to treat pulmonary infections © Paradigm Publishing, Inc.
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Dispensing Issues of Macrolides
Most antibiotics taken on empty stomach Some forms of erythromycin can cause severe GI distress and should be taken with food © Paradigm Publishing, Inc.
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Dispensing Issues of Macrolides
Warning! Can be misread erythromycin azithromycin Dosing should help identify drug © Paradigm Publishing, Inc.
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Ketolides Bind to ribosomal subunits and block protein synthesis May inhibit newly forming ribosomes Bacteria resistant to macrolides, lincomycin derivatives, and streptogramins is also resistant to ketolides Used to treat bacterial infections in lungs and sinuses © Paradigm Publishing, Inc.
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Quinolones Strong, rapid bactericidal action against Most gram-negative bacteria Many gram-positive bacteria Antagonize enzyme responsible for coiling and replicating DNA, causing DNA breakage and cell death © Paradigm Publishing, Inc.
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Therapeutic Uses of Quinolones
Bone and joint infections caused by gram-negative organisms Infectious diarrhea Ophthalmic infections (ciprofloxacin) Some sexually transmitted diseases Upper respiratory infections Urinary tract infections (UTIs) © Paradigm Publishing, Inc.
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Side Effects of Quinolones
Primarily gastrointestinal, with nausea and vomiting Some joint swelling, dizziness, and unpleasant taste Can cause joint problems and malformations Patients have tendency to injure tendons © Paradigm Publishing, Inc.
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Dispensing Issues of Quinolones
Not to be given with theophylline Antacids interfere with absorption Avoid sun © Paradigm Publishing, Inc.
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Streptogramins Inhibit protein synthesis within the bacterial ribosomes Alternative to vancomycin Side effects similar to quinolones: nausea, vomiting, joint swelling, dizziness © Paradigm Publishing, Inc.
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Aminoglycosides Used to treat serious infections: Sepsis Inhibits bacterial protein synthesis by binding to ribosomal subunits After first dose, dosage adjusted according to plasma concentrations © Paradigm Publishing, Inc.
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Side Effects of Aminoglycosides
Nephrotoxicity (destructive to kidney) Ototoxicity (damage organs of hearing) Equilibrium problems Tinnitus Permanent deafness Neuromuscular blockade © Paradigm Publishing, Inc.
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Dosing of Aminoglycosides
Dosed 1x/daily instead of 2 to 3x/daily Less frequent dosing may reduce toxicity Less drug accumulates in kidneys and ears Simplifies drug monitoring Trough levels should be checked before second dose to confirm drug elimination © Paradigm Publishing, Inc.
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Cyclic Lipopetides Bind bacterial membranes causing cell membrane to depolarize Leads to Inhibition of DNA and RNA synthesis Bacterial death © Paradigm Publishing, Inc.
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Drug List Cyclic Lipopetides daptomycin (Cubicin) Do not take with statins: causes hypotension © Paradigm Publishing, Inc.
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Terms to Remember sulfonamides penicillin cephalosporin community-acquired NS D5W © Paradigm Publishing, Inc.
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Terms to Remember tetracycline chelation macrolide ketolide quinolone streptogramin © Paradigm Publishing, Inc.
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Terms to Remember aminoglycoside sepsis nephrotoxicity ototoxicity cyclic lipopeptide hypotension © Paradigm Publishing, Inc.
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Other Antibiotics Five important antibiotics are structurally distinct from Those in other classes Each other © Paradigm Publishing, Inc.
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vancomycin (Vancocin)
Warning! Bacterial resistance increasing due to overuse Strict CDC guidelines for handling and use Adverse effect: Red man syndrome © Paradigm Publishing, Inc.
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clindamycin (Cleocin)
Broad-spectrum antibiotic used for Acne Penicillin alternative in dental prophylaxis Anaerobic pneumonia Bone and bowel infections Female genital and intra-abdominal infections © Paradigm Publishing, Inc.
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clindamycin (Cleocin)
Warning! If patient develops diarrhea, drug must be discontinued © Paradigm Publishing, Inc.
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linezolid (Zyvox) First oxazolidinone approved by FDA Inhibits bacterial protein synthesis Drug must be protected from light TX: MRSA, VRE, other gram positive IV, oral, tablet Cannot go in the IV with other drugs © Paradigm Publishing, Inc.
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metronidazole (Flagyl)
Effective against Fungi, protozoa and bacteria Pharmacy technician—place No Alcohol warning sticker on medication © Paradigm Publishing, Inc.
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pentamidine (NebuPent, Pentam)
Second-line agent for Pneumocystis carinii Mechanism of action unknown Patient may develop sudden hypotension (low blood pressure) © Paradigm Publishing, Inc.
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Storage of Liquid Antibiotics
After lyophilized (powdered) antibiotics are mixed Some need refrigeration Others stored at room temperature Pharmacy technician may tell storage information to patient © Paradigm Publishing, Inc.
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Ophthalmic Antibiotics
Some antibiotics have ophthalmic (eye) dosage forms Very few antibiotics have otic forms Very painful in the eye Otic medicines have different pH than the eye © Paradigm Publishing, Inc.
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Dispensing Issues of Ophthalmic Antibiotics
Newer eye drops very expensive, often rejected by insurance companies Pharmacy technician will need to let prescriber know What eye drops are available Which ones insurance most likely cover © Paradigm Publishing, Inc.
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Terms to Remember ophthalmic to be used in the eye otic to be used in the ear pH a measurement of acidity or alkalinity; pH 7 neutral © Paradigm Publishing, Inc.
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Treating Complications of Infections
drotrecogin alfa (Xigris) Not an antibiotic Used in treating some complications of sepsis (life-threatening result of serious infections) Anticoagulant and anti-inflammatory High cost, strict guidelines limit use © Paradigm Publishing, Inc.
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Drug List Adjunct in Treating Sepsis drotrecogin alfa (Xigris) © Paradigm Publishing, Inc.
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Discussion Why is resistance developing to antibiotics? Is this a problem? What role can the pharmacy technician play in regard to this problem? © Paradigm Publishing, Inc.
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