Lecture 9: Infection 5&6

Lecture 9: Infection 5&6 * + carbapenems Antimicrobials/Antibiotics/Antiinfectives: ① cell wall synthesis inhibitors ② protein synthesis inhibitors * ③ nucleic acid inhibitors (DNA, RNA) ④ antimetabolites + lincosamides Protein Synthesis Inhibitors · Macrolides (erythromycin) · Tetracyclines · Aminoglycosides (Streptomycin) · Chloramphenicol · Lincosamides + fluoroquinolones + nitroimidazoles + sulfonamides Macrolides · -mycin suffix (mostly) · efficacy: community acquired adult pneumonia, gonorrhea · medications: erythromycin, -1 azithromycin (Zithromax), Clarithromycin (Biaxin) Tetracyclines · -ycline suffix · spectrum: G+ and G· drugs: Tetracycline, doxycycline, minocycline ↳ tetracycline and doxycycline can cause bone deformations · tetracyclines are often used as acne treatment, but for adolescent acne (acne vulgaris) we only use minocycline b/c it doesn't cause bone deformation · also used for skin infections or pneumonia (mainly doxycycline) A - - - - * - Aminoglycosides · potent, can penetrate the BBB · narrow TI: must assess serum levels before each dose * · drugs: gentamicin, streptomycin, neomycin, tobramycin ↳ side effect of cytotoxicity · used for higher risk infections (except tobramycin eye drops for bacterial conjunctivitis) A - Lincosamides A · commonly used for surgical prophylaxis · drugs: Clindamycin, Lincomycin A - Meningitis · inflammation of meninges; pia mater, arachnoid & subarachnoid space ↳ spreads quickly through CSF · bacterial or viral · common pathogens: S. pneumoniae, N. meningitidis, Hib · toxin production, inflammation, vasodilation, edema (increased ICP), tissue congestion, adhesion formation, and impaired circulation · diagnosis: CSF culture, blood culture · signs & symptoms: Stiff neck, photophobia, headache, fever, petechiae ↳ petechial rash is non-blanching b/c DIC hemorrhaging · Treatments → CSF or blood culture ↳ glucocorticoid: dexamethasone - decreases inflammation - protects CNS from inflammation damage ↳ aminoglycosides: gentamicin? Acne Vulgaris (most common) · inflammation of the pilosebaceous Skin unit (pore) · most often found during puberty (high androgen hormone levels) ↳ more often in men b/c of testosterone · pathology: increased sebum and trapping of sebum can lead to the creation of biofilms which are hard to treat with topical creams · severity is based on number of affected pores · acne most common on face, neck, and upper torso · treatments: ① Retinoids ↳ Vitamin A drug derivative that increases regeneration and decreases sebum production ↳ drugs: Retin-A (topical cream), Accutane (isotretinoin)(PO) - note: accutane causes break down of muscle fibers so you must monitor creatine clearance (BW monitoring) to prevent renal failure - female patients must be on birth control b/c it is pregnancy category X ② Antibiotics ↳ eliminate bacterial proliferation, decrease inflammation ↳ tetracyclines: minocycline ③ Estrogens ↳ negative feedback system on testosterone synthesis (not given to men) ④ keep clean! - - - - Herpes Simplex · simplex 1: oral herpes ↳ sore on lips, tongue (circular) ↳ spread by direct contact and saliva · simplex 2: genital herpes ↳ sores on genitals in clusters ↳ spread by direct contact · herpes is only contagious when the sore is present, but disease never goes away · diagnosis: routine testing doesn't work since herpes is viral, but antibodies in blood may show previous exposure · treatment: antivirals such as valacyclovir, acyclovir (topical, PO, or IV) Varicella Zoster (Chickenpox) · contagious, transmission is direct contact and airborne · pediatric S&S: itchy, malaise, fever, rash ↳ rash is macular to papular to vesicular to crusting (present in all stages all over) ↳ rash first appears on chest, back, and face · adults S&S: pneumonia, organ complications, rash on dermatome · regular treatment: antihistamines, antipyretics · severe treatment: immunoglobulins (boost immunity) → acyclovir for shingles