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CHAPTER 7 Immunizations and Antimicrobials 7-2 Introduction • This chapter covers ─Disease terminology/concepts ─Immunizations ─Antimicrobials ─Active and passive immunity ─Proper use of anti-infective agents 7-3 General Disease Terminology • Disease – Not (dis) at ease – Body fails to function properly – Numerous causes – Many due to infections • Sign – Objective – Measurable – Definitive (Continues) 7-4 General Disease Terminology • Symptom – Subjective – Based on perception – Cannot be measured consistently • Syndrome – Specific grouping of signs/symptoms (S/S) • Diagnosis – Identification of disease (Continues) 7-5 General Disease Terminology • Prognosis – Prediction of outcome of disease process • Chief complaint – Concern that caused patient to seek medical help • Etiology – Cause of disease (Continues) 7-6 General Disease Terminology • Chronic condition – Long term • Acute condition – Short term • Remission – S/S of chronic disease may subside • Relapse – Recurrence of S/S (Continues) 7-7 General Disease Terminology • Exacerbation – Acute return of S/S • Mortality – Measure of deaths attributed to specific disease • Morbidity – Measure of disability/problems related to illness (Continues) 7-8 General Disease Terminology • Epidemiology – Study of patterns, causes, spread, and effects of disease conditions (as determined by CDC) • Endemic – Disease continually present within a specific population/region • Epidemic – Disease occurs suddenly over specific geographic region (Continues) 7-9 General Disease Terminology • Pandemic – Disease spreads throughout country or worldwide • Reminder – It is better to prevent infections (such as with the use of vaccinations) than it is to treat them 7-10 Immunity • Immune response produces antibodies against foreign microbes; inherited, acquired, induced • Two broad types – Active: produced artificially (vaccination), or naturally (by contracting illness); long-lasting – Passive: administration of immunoglobulins; short-lived 7-11 Microbial Resistance Mechanisms • Resistance occurrence may be due to – Antibiotic being destroyed by bacterial enzymes – Alteration in protein binding – Bacteria pumping antibiotic out, preventing it from destroying bacteria – Use of antibiotics when not needed 7-12 Antibacterial Drug Classification • Bacteriostatic (inhibits replications) versus bactericidal (actively destroys bacteria) • Broad-spectrum (effective against wide range of bacteria) versus narrow spectrum (used after specific organism is identified) • Mechanism of action (commonly used to classify HIV medications) 7-13 Antibacterial Agents • Refer to text for in-depth information concerning these agents • Beta-lactams – Chemically related drugs – Inhibit materials needed for bacterial cell wall synthesis – For example, penicillins, cephalosporins, monobactams, carbacephems, carbapenems (Continues) 7-14 Antibacterial Agents • Quinolones – Block two enzymes responsible for DNA growth, leading to breakage of DNA, which results in bactericidal activity – Prolonged use may cause superinfection – May cause tendon inflammation with rupture, even after medication is discontinued – Example of fluoroquinolones: ciprofloxacin (Continues) 7-15 Antibacterial Agents • Aminoglycosides – Gram-negative coverage – Bactericidal – Dosage based on patient weight, renal function, and serum blood levels – May cause hearing loss and kidney failure – For example, amikacin, gentamicin, tobramycin (Continues) 7-16 Antibacterial Agents • Glycopeptides – Bactericidal – Bind to portion of cell wall of microorganism, preventing cell wall development – Effective against gram-positive cocci – For example, vancomycin (monitor serum blood levels), telavancin (has long duration; given once daily) (Continues) 7-17 Antibacterial Agents • Macrolides – Inhibit bacterial protein synthesis – Commonly used for pulmonary infections • Tetracyclines – Broad spectrum – Bacteriostatic – Can cause permanent tooth discoloration (Continues) 7-18 Antibacterial Agents • Folate inhibitors – Bacteriostatic – Primary use: treatment of UTIs – Sulfonamides • Quinupristin-Dalfopristin – Inhibit bacterial protein synthesis – Bacteriostatic against gram-positive bacteria – Administered IV (Continues) 7-19 Antibacterial Agents • Daptomycin – Bactericidal against gram-positive bacteria – Interferes with electrical activity of cell membrane – Useful in treatment of MRSA • Clindamycin – Oral or IV – Active against gram-positive cocci, anaerobes (Continues) 7-20 Antibacterial Agents • Metronidazole – Synthetic drug – Anaerobic spectrum of activity – Inhibits bacterial protein synthesis resulting in cell death – Part of cocktail drug to treat peptic ulcer disease (PUD) due to H. pylori 7-21 Antituberculosis Drugs • TB – May affect lungs, kidneys, spine, and brain; air-borne transmission; chronic • MDR TB – Due to suboptimal treatment (inappropriate drug doses/noncompliance) • Treatment – For example, rifampin, isoniazid 7-22 Antivirals • Vaccinations as prevention are preferred over treatment of viruses • HSV – Treatment interferes with viral DNA synthesis, thus inhibiting viral replication – For example, valacyclovir • Influenza – Prevention available through oral administration, inhalation, or vaccination (Continues) 7-23 Antivirals • RSV – Major cause of lung disease in children – Treatment includes: ribavirin (inhibits RNA and DNA viruses) • HCV – Most common blood-borne infection in the United States – Treatment examples: simeprevir, peginterferon (Continues) 7-24 Antivirals • HIV – Infects cells of immune system – May progress to AIDS – Treatment: antiretrovirals that include several drug classes • NRTIs (e.g., abacavir) • NNRTIs (e.g., efavirenz) • PIs (e.g., ritonavir) 7-25 Antifungal Agents • Two basic forms of fungi in humans – Yeasts – Molds • Fungi may be local or systemic • Treatments prevent production of ergosterol • Example: nystatin (oral or topical cream), miconazole (topical) 7-26 Summary • Learn and understand general disease terminology to lay the foundation for discussions on infectious diseases • Immunity – Passive – Active 7-27 Summary • Microbial resistance mechanisms • Anti-infective agents – Antibacterial agents – Antituberculosis drugs – Antivirals – Antifungals 7-28