Download EO 003.01 - Part 23 - Anti-infectives for Systemic Use

Anti-infective Drugs for
Systemic Use
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EO 003.01 Part 23
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Lesson Overview
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Antibacterials for Systemic Use
• Bacteria
- characteristics
- what is a pathogen?
• Classes of antibiotics:
- Tetracyclines
- Amphenicols
- Beta-lactams
- Sufonamides
- Macrolides
- Aminoglycosides
- Fluoroquinolones
- Other antibiotics
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Antimycotics for Systemic Use
• Fungi
-characteristics
• Antimycotics
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Lesson Overview
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Antivirals for Systemic Use
• Viruses
• Types of antivirals
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Immune Sera and Immunoglobulins
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What I need to know as a pharmacy technician
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In this lecture we will cover the drugs listed
in the ANA Formulary which are classified
according to the ATC system under
(J) Anti-infectives for Systemic Use
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For each of these medications/classes
students must obtain an understanding of:
(1) Mechanism of Action
(2) Indications (Uses)
(3) Efficacy
(4) Side Effects
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Infections
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An infection is the invasion of the
human body by a disease causing
organism such as:
(1)
(2)
(3)
(4)
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Bacteria
Virus
Fungi
Parasite
Note: Antiparasitics will be covered in
another lecture.
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Anti-bacterials for Systemic Use
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What are bacteria?
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• Single celled organisms
• Very small
• Need a microscope to see
• Can be found on most materials and surfaces
• Billions on and in your body right now
- can be harmful (cause infection)
- can be helpful
This E. coli helps you
digest food.
Streptococcus can
cause strep throat.
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What do they look like?
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Three basic shapes
(1) Rod shaped called bacilli
(2) Round shaped called cocci
(3) Spiral shaped
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Some exist as single cells, others
cluster together
Cluster of cocci
Bacilli
Cocci
Spiral
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Bacteria are ALIVE!
• They reproduce (make more of
themselves).
• They have some of the same
components as human cells:
(1) Nucleoid (similar to nucleus)
(2) Ribosomes to produce protein
(3) Cytoplasm
• And some unique components:
(1) Cell wall
(2) Capsule
(3) Flagella
(4) Pili
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Characteristics of Bacteria
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Cell Wall
A rigid layer made up of
peptidoglycan.
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Cells can be gram positive or
negative.
Gram negative cells have an
outer layer which protects
the cell wall.
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Characteristics of Bacteria Continued
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Anaerobic vs. Aerobic
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Aerobic – require oxygen
Anaerobic – can function without
oxygen
Cell secretions
Many bacteria secrete enzymes that
make their living environment more
favorable.
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How do bacteria reproduce?
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•
Grow in number not in size
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• Make copies of themselves
by dividing in half
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How do bacteria obtain nutrients?
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• Some make their own food
from sunlight—like plants.
• Some are scavengers and share
the environment around them.
Example: The bacteria in your
stomach are now eating what you
ate for breakfast.
•Some are warriors (pathogens),
they attack other living things in
order to obtain nutrients.
Example: The bacteria on your
face can attack the skin causing
infection.
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Photosynthetic
bacteria
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Harmless bacteria on the
stomach lining
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A pathogen
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How does a pathogen enter the body?
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Contact with people who are
sick:
• Direct (physical contact)
• Indirect
- airborne (through
coughing/aspirating).
- body secretions
- insect bites
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Food, water, or other surfaces
that are contaminated
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Common Pathogens
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What is an Antibacterial?
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Antibacterial drugs are substances
that inhibit the growth of bacteria or
kill bacteria.
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Bacteriostatic = inhibits growth
Bactericidal = kills bacteria
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ANA Formulary
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Why are there so many different types of
Antibacterials?
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When a doctor is wanting to treat a
patient with an antibiotic there are
many factors that they must consider,
which affect their choice of antibiotic
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What are the characteristics of the
pathogen?
(1) Gram positive/negative –
antibiotics that destroy the cell wall
do not work well against gram
negative bacteria.
(2) Anaerobic/aerobic – antibiotics
that target the use of oxygen will be
ineffective again anaerobic
bacteria.
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Why are there so many different types of
Antibacterials?
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(3) Patient characteristics
Certain antibiotics cannot be used in
children or pregnant women.
Some patients may have allergies to
certain classes of antibiotics.
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* These are just a few examples of
factors to be taken into account, there
are many more.
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Tetracyclines
‫تيتراسيكلين‬
Mechanism of Action
• Act at the ribosome to
inhibit bacterial protein
synthesis.
Indications (Uses)
• Used to treat skin infections
(i.e. bad acne).
• Can be used to treat
bronchitis.
• Can be used to treat
H.Pylori infection in the
stomach which causes
ulcers.
:‫تاثيرات‬
‫• سبب نهي وسنتيز‬
‫پروتين بكتري‬
‫ميشود‬
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Tetracyclines
‫تيتراسيكلين‬
Side Effects
– Photosensitivity
– Yellow-gray-brown
discoloration of teeth.
– May cause diarrhea and upset
stomach.
Important points
– Not recommended for
children under 9 due to teeth
discoloration.
– Not recommended for women
who are pregnant (can cause
damage to the unborn baby).
– Do not take antacids,
laxatives or products
containing mineral (i.e. iron
and calcium) within 2 hours
of taking Tetracycline
‫عوارض جانبي‬
‫ حساسيت درمقابل شعاع‬-‫ زر د – خاكستري‬‫خرمائي بي رنگ شدن دندان‬
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‫نبايد براي اطفال زير سنين‬‫ ساله وجنين درحال رشد‬9
‫توصيه گردد‬
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Chloramphenicol
‫کلورامفینیکول‬
Mechanism of Action
• Act at the ribosome to
inhibit bacterial protein
synthesis.
Indication
• This is an old antibiotic that
is rarely used anymore due
to concerns with toxicity.
• Can be used to treat typhus.
:‫تاثيرات‬
‫• سبب نهي وسنتيز‬
‫پروتين بكتري‬
‫ميشود‬
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Chloramphenicol
‫کلورامفینیکول‬
Side Effects
• Bone marrow suppression
which can =anemia.
• Diarrhea
• Feeling lightheaded (low
blood pressure).
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Important Points
• Many drug interactions
exist with this medication.
• Should not be used in very
young babies.
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Penicillins
‫پینیسیلین ها‬
Mechanism of Action
Inhibit bacterial cell wall synthesis
exposing the less stable membrane
which can lead to cell lysis.
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Depends on ability to cross bacterial
cell wall:
Gram positive bacteria have a cell wall
that penicillin can cross.
Gram negative bacteria have a membrane
that acts as a barrier.
Resistance to pennicillin –due to
inactivation of the antibiotic by βlactamase, an enzyme secreted by the
bacteria.
Sometimes these antibiotics will be
combined with a β-lactamase
inhibitor such as tazobactam to
increase activity of the antibiotic.
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Penicillins
Indications
Common infections:
‫پینیسیلین ها‬
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- pharyngitis
- otitis media
- minor skin infections.
Serious infections:
- infective endocarditis
- meningitis
- syphillis
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Penicillins
‫پینیسیلین ها‬
Side Effects
• may cause stomach upset
• diarrhea
• rash (if severe (hives) patient should
see doctor right away as it may be
anaphylaxis).
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Important
Best to take on an empty stomach (if
possible) – meaning 1 hr before or 2hrs
after a meal.
Some patients are allergic to penicillins
(important to check allergies with the
patient.
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Cephalosporins
‫سیفالوسپورین ها‬
Mechanism of Action
Same as penicillins - inhibit
bacterial cell wall synthesis
exposing the less stable
membrane which can lead to
cell lysis.
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Indications
Used in many different types of
infections:
• Sinusitis
• Pharyngitis
• Otitis media
• Skin infections
• Urinary tract infections
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Cephalosporins
‫سیفالوسپورین ها‬
Side Effects
• Diarrhea
• Upset stomach
• Increased sensitivity to sun.
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Includes
• Cephalexin
• Cefazolin
• Ceftriaxone
• Cefixime
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Carbapenems
‫کارباپینم ها‬
Imipenem/Cilastin
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Mechanism of Action
Imipenem – same as beta lactams.
Cilastin – prevents imipenem from
being broken down in the body.
Indications
Many infections (generally of a more
serious nature)
• lower respiratory tract
• urinary tract,
• intra-abdominal,
• gynecologic,
• bone and joint,
• skin
• endocarditis
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Carbapenems
‫کارباپینم ها‬
Side Effects
• Diarrhea
• Upset stomach
• Rare: Severe rash, seizures
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Sulfonamides
‫سلفاميدها‬
Mechanism of Action
Interferes with synthesis of
folate which is essential for the
production of amino acids
which form proteins.
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Trimethoprim – interferes with
the production of folate.
Indications
Used to treat many different
types of infections
• urinary tract infections
• respiratory infections (in
patients with HIV)
• prostatitis
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Sulfonamides
‫سلفاميدها‬
Side Effects
• Diarrhea
• Upset stomach
• Rash, can be minor or in
rare cases very severe.
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Important Point
Patients may be allergic to
sulfonamides, it is important to
check allergies with the patient.
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Macrolides
‫ماکرولید ها‬
Mechanism of Action
Interferes with protein synthesis
in the bacteria.
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Indications
• sinusitis
• pneumonia
• chlamydia
Side Effects
• diarrhea
• upset stomach
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Aminoglycosides
‫امینوگالیکوزید ها‬
Mechanism of Action
Interferes with protein synthesis
in the bacteria.
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Synergistic effect with betalactams, because beta-lactams
break down the cell wall
allowing the aminoglycosides
to enter the cell.
Indications
Used for more severe
infections:
•septicemia,
•respiratory tract infections,
complicated urinary tract
infections
•complicated intra-abdominal
infections
•osteomyelitis (bone infection)
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Aminoglycosides
‫امینوگالیکوزید ها‬
Side Effects
• problems with hearing
(deafness).
• kidney problems.
• rash
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Important Points
• Administered by IV
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Fluoroquinolones
‫فولروکینولون ها‬
Mechanism of Action
Interfere with the replication of
bacterial DNA, thus preventing
cell replication.
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Indications
• Respiratory tract infections
• Urinary tract infections
• Prostatitis
• Infectious diarrhea
Side Effects
• Diarrhea
• Nausea/upset stomach
• Tendon ruptures have been
reported.
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Fluoroquinolones
‫فولروکینولون ها‬
Important Points
• Not for use in pregnant
women or children.
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Vancomycin
‫وانکومایسین‬
Mechanism of Action
Inhibits bacterial cell wall
synthesis.
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Indications (Use)
• For methicillin resistant
infections
• For life threatening C.Diff
infections.
Side Effects
• red-man syndrome if infused
too fast
• Ringing in the ears.
• Can cause kidney problems
Important Points
Administered intravenously
Requires laboratory monitoring
of drug levels to achieve effect.
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Fosfomycin
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Mechanism of Action
Prevents the synthesis of the
bacterial cell wall.
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Indications (Uses)
Used in complicated urinary
tract infections.
Side Effects
• Upset stomach
• Diarrhea
Important Points
Administered orally
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Linezolid
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Mechanism of Action
Prevents bacterial protein
synthesis.
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Indications (Use)
Generally used to treat
infections which are resistant to
vancomycin.
Side Effects
• Diarrhea
• Upset stomach
• Signs of low blood sugar
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Antimycotics for Systemic Use
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Mycosis
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Mycosis – a fungal infection.
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Inhalation of fungal spores or
localized colonization of the
skin may initiate persistent
infections; therefore, mycoses
often start in the lungs or on the
skin.
Fungus - any of a group of
unicellular, multicellular, or
spore-producing organisms
feeding on organic matter. This
includes mold and yeast.
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Fungal infection of the nails (tinea pedis)
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Severe fungal infection of the skin
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Mechanism of Action
Interferes with the formation of
the cell membrane.
Fluconazole
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Indications (Use)
Used to treat yeast infections.
Side Effects
Generally well tolerated
Mild side effects include:
• headache
• diarrhea
• upset stomach
Important Points
Many drug interactions exist.
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Nystatin
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Mechanism of Action
Degrades the cell wall.
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Indications (Use)
Also used to treat yeast
infections, generally of the
mouth.
Side Effects
• Upset stomach
• Diarrhea
Important Points
Patients should swish the
solution around in their mouth
for at least 60 seconds before
swallowing.
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Anti-virals for Systemic Use
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Viruses
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A virus is a small infectious
agent that replicates only inside
the living cells of other
organisms. Viruses can infect
all types of life forms, from
animals and plants to bacteria.
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Viruses are responsible for
causing a wide variety of
illnesses from the ‘common
cold’ to the human
immunodeficiency virus (HIV).
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Viral Replication
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Viral populations do not grow
through cell division.
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Instead, they use the machinery and
metabolism of a host cell to produce
multiple copies of themselves.
They do this by having viral genetic
material copied in the host cell.
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Antiviral Drugs: Acyclovir
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Mechanism of Action
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Prevents replication of the
Herpes Simplex Virus by
disrupting the replication of
genetic material.
Indications (Uses)
Used to treat Herpes Simplex
infections
• shingles
• cold sores
• genital herpes
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Antiviral Drugs:
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Side Effects
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Generally well tolerated in
patients.
Rare but severe side effects
include:
- kidney problems
- neurotoxicity
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Other Antiviral Drugs
‫ادويه ضد ويروس‬
Mechanism of Action
Inhibit viral DNA replication.
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Indications (Use)
Lamivudine and Entecavir–
HIV and Hepatitis B
Ritinavir – Respiratory Simplex
Virus (RSV) and Hepatitis C
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Other Antiviral Drugs
‫ادويه ضد ويروس‬
Side Effects
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Lamivudine – headache,
diarrhea, low energy levels,
dizziness, muscle pain and
disruption of sleep.
Entecavir – liver problems,
blood in the urine, upset
stomach and dizziness.
Ritinavir – skin irritation, hair
loss, diarrhea, disruption of
sleep and loss of appetite.
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Immune Sera and Immunoglobulins
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These are blood products that
are usually not controlled by
the pharmacy department.
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Hepatitis B Immune globulin
Given to patients who have
been exposed to contaminated
blood or blood products (i.e.
needle prick injury) to prevent
them from getting hepatitis B.
Anti-tetanus Immune
globulin
Given to patients who have
possibly been exposed to
tetanus and have not been
previously vaccinated.
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Questions?
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In-class Assignment
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This assignment will consist of 7 questions
which are to be completed individually.
Once complete the instructor will review the
answers with the class.
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1. A human cell has all of the following components in
common with bacterial cells EXCEPT for?
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A)
B)
C)
D)
Ribosomes
Cytoplasm
Cell wall
Cell membrane
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1. Answer: A human cell has all of the following
components in common with bacterial cells EXCEPT for?
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A)
B)
C)
D)
Ribosomes
Cytoplasm
Cell wall
Cell membrane
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2.Which of the following are key characteristics of
bacteria?
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A) Gram positive/negative
B) Aerobic/anaerobic
C) Secrete enzymes and other
substances
D) All of the above
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2.Which of the following are key characteristics of
bacteria?
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A) Gram positive/negative
B) Aerobic/anaerobic
C) Secrete enzymes and other
substances
D) All of the above
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3. True of False: A physician can just pick any antibiotic at
random to treat an infection.
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3. Answer: True of False: A physician can just pick any
antibiotic at random to treat an infection.
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Answer: False, a doctor must consider various factors
regarding the pathogen such as: gram postive/negative,
aerobic anaerobic etc.
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4. Match the following antibiotics with their correct class?
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A)
B)
C)
D)
Amoxicillin
Sulfamethoxazole/Trimethoprim
Azithromycin
Gentamicin
1)
2)
3)
4)
Aminoglycoside
Sulfonamide
Macrolide
Pennicillin
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4. Answer: Match the following antibiotics with their
correct class?
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A) Amoxicillin – (4) Pennicillin
B) Sulfamethoxazole/Trimethoprim
(2) Sulfonamide
C) Azithromycin (3) Macrolide
D) Gentamicin (1) Aminglycoside
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5. Match the following antibiotics with
their mechanism of action (each mechanism can be used
more than once).
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A) Pennicillin
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B) Gentamicin
C) Vancomycin
D) Ciprofloxacin
1) Interfere with protein
synthesis
2) Interfere with cell wall
synthesis
3) Interfere with DNA
replication
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5. Answer: Match the following antibiotics with
their mechanism of action (each mechanism can be used
more than once).
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A) Pennicillin (2) interferes
with cell wall synthesis
B) Gentamicin (1) interfere
with protein synthesis
C) Vancomycin (2) interferes
with cell wall synthesis
D) Ciprofloxacin (3) interferes
with DNA replication
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6. Which of the following statements are NOT true?
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A) A virus is a small infectious
agent.
B) A virus can cause a variety
of illnesses from the
common cold to HIV.
C) A virus can multiply on its
own, outside of a host cell.
D) Acyclovir is an antiviral
used to treat shingles and
other herpes infections.
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6. Answer: Which of the following statements are NOT
true?
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A) A virus is a small infectious
agent.
B) A virus can cause a variety
of illnesses from the
common cold to HIV.
C) A virus can multiply on its
own, outside of a host cell.
D) Acyclovir is an antiviral
used to treat shingles and
other herpes infections.
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7. Which of the following drugs are used to treat yeast
infections?
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A)
B)
C)
D)
Ciprofloxacin
Fluconazole
Acyclovir
Amoxicillin
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7. Which of the following drugs are used to treat yeast
infections?
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A)
B)
C)
D)
Ciprofloxacin
Fluconazole
Acyclovir
Amoxicillin
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