Pharmacology Exam 2

What are examples of antibiotic misuse?

*Failing to complete the entire prescribed course of an antibiotic - only more susceptible organisms are killed off allowing remaining organisms to grow with less competition *Saving unused medication and taking without a physician order (i.e., "self-prescribing") *Prescribing antibiotics for viral infection with patient exposure to risks of the drug without the benefits. [When is it appropriate for a person with a viral infection to receive antibiotics?] *Prescribing antibiotics in a normally healthy person because a fever is present *Taking antibiotics prescribed for another person

What are the indications for vaccines?

1. initial immunizations against diseases in children 2.booster immunization against disease as indicated by age and disease process 3.passive immunization for those who cannot take active immunizations 4.passive immunization in illnesses where active immunization is not available or applicable

Standards for childhood Immunizations

8 infectious diseases, plus Hep A and Human papillomavirus

____ develops over the lifetime as the individual is exposed to disease and develops immunity or is given a disease agent to stimulate the immune response.

Acquired immunity

A form of acquired immunity that develops in an individual in response to an immunogen (antigen) is known as ____.

Active Immunity

_____ are the active component of humoral immunity that differentiate into plasma cells to produce and secrete immunoglobulins.

B lymphocytes

Which of the following is a live attenuated vaccine?

BCG

Standards of immunizations for adults age 65 and older

Boosters every 10yrs *Diphteria *tetanus toxoid Booster every 5 yrs *pneumococcal

Antimicrobial choice is based on

Causative organism Drug sensitivity Ability to penetrate the site of infection Host factors.

T cells, which compromise about 80% of circulating lymphocytes, are the primary cells that provide ____.

Cell Mediated Immunity

Antibody titer

Determines if the individual has immunity

Richard has an infected lesion on his leg. Dr. Merry orders a prescription topical antibiotic to be applied to the lesion tid. Richard has taken multiple antibiotics in the past for a variety of illnesses. Select all true statements about this case.

Dr. Merry would order an oral antibiotic if Richard showed signs and symptoms of a systemic infection. Dr. Merry did not order an oral antibiotic because there was no indication of a systemic infection. The local antibiotic is less likely to cause cross-resistance given Richard's history of antibiotic use.

What is drug resistance?

Drug resistance; Cross resistance

long term, up to a life time

Duration

Attenuated vaccines are made of whole killed or inactivated microbes or some of their components; e.g., influenza, pertussis, and rabies vaccines.

False

Host Factors

Immune Status Metabolism Allergy Childbearing Status

The ability to resist infection and disease through the activation of specific defenses is known as ______.

Immunity

2 of the main groups of drugs that are classified as biologics by the FDA.

Immunizing agents and allergenic extract

Contraction of disease or Immunization with toxoid or vaccine

Method of immunity

Lymphocytes respond to the presence of cancer cells, foreign proteins, and invading:

Pathogens

Indications of prophylaxis

Prevention of endocarditis prior to surgery or dental procedures in individuals with congenital or valvular heart disease, history of rheumatic fever, or having certain prostheses STD diagnosis (intercourse with person known to have infection) before signs and symptoms appear Neutropenia (decreased WBCs) due to chemotherapy or other causes.

Disease Prevention

Purpose

5-21 days

Response time

Immunoglobulins are antibodies found in serum that are used in the prevention of diseases, such as hepatitis B, tetanus, and rabies. Specific conditions may also require the administration of immunoglobulins. Select all correct statements.

RhoGAM is an antibody preparation given after delivery to de-sensitize a RH-negative mother who delivers a RH-positive baby. RSV immune globulin for lower respiratory diseases is administered to premature babies.

Methods for differentiating types of bacteria

Shape — *Coccus = round *Bacillus = rod-shaped *Spirilla = spiral-shaped Gram-stain properties — *Gram-positive = purple stain *Gram-negative = no stain Oxygen or not? *Yes = aerobic *No = anaerobic *Facultative = survive in either environment

Antimicrobial resistance is a growing public health issue. Refer to this FDA-sponsored video in the lecture notes on this issue and select all correct statements about how resistance occurs.

Some mechanisms of antimicrobial resistance include mutuation, destruction (or inactivation), and efflux. Selection pressure is the outcome of natural selection, or the Darwinian principle of the "survival of the fittest", which has resulted in the ability of microorganisms to develop resistance to antimicrobials. Transduction occurs as bacterial DNA is transferred from one bacterium to another inside a virus that infects bacteria, called a phage, which then takes over the infected bacterium genetic processes to produce more phages that can infect other bacteria with the resistant DNA. Antimicrobial resistance can occur as a result of genetic transfer via conjugation, transformation, or transduction.

self-Produced Immunity

Source

Annually, the Centers for Disease Control and Prevention (CDC) issue statements of recommended vaccines. Therefore, health care professionals should check the immunization schedules each year. Parents can also look up the schedules to identify immunizations and time frames for receiving. There are several sites to check including the CDC, American Academy of Pediatrics and the American Academy of Family Physicians. Go to http://www.cdc.gov/ (Links to an external site.)and locate the 2019 immunization schedule for ages 0-15 months. Refer to 2019 schedule for the next 2 questions and select the true statements.

The first dose of IPV is given at 2 months of age. The dosing schedule for the DTaP series from 0-15 months is 2, 4, 6, and 15-18 months.

Jane Smith developed community-acquired pneumonia and was treated with amoxicillin (broad-spectrum synthetic penicillin). After 5 days of treatment, she experienced soreness of her mouth and throat with white patches on her tongue and oral mucosa. She likely has Candida albicans. How did this superinfection occur?

The penicillin altered the balance of Jane's normal flora causing an overgrowth of Candida which is normally found on the skin and mucous membranes.

Sara Jones is a 20-year-old college student. She wakes up with an extremely sore throat. Sara calls the doctor's office stating that she has a cold and a sore throat and requests a prescription for an antibiotic. Select all true statements about this case.

When the culture and sensitivity results are reported, the doctor may change the prescription to a narrow-spectrum antibiotic specific to the identified organism. The doctor will not order an antibiotic, but may schedule an office visit once more information is obtained about her signs and symptoms. Once the doctor sees Sara and determines that her signs/symptoms point to strep pharyngitis, the doctor will order a broad-spectrum antibiotic until the throat culture results are reported.

Drug resistance

ability of bacteria and other microbes to resist the effects of an antibiotic or other antimicrobial to which they were once sensitive Bacteria become resistant by mutating or changing genetic structure.

tetracycline is contraindicated in all of the following except _______.

adolescence

For the most effective treatment of an infection, the causative microorganism should be identified along with its drug susceptibility (or sensitivity) to the medication. One way of identifying microorganisms is by oxygen requirement. A bacterium that requires an oxygen-free environment is__.The bacterium that can survive with or without oxygen is termed___.A bacterium that requires oxygen to live is___.

anaerobic; facultative; aerobic

Special proteins that are made by lymphocytes that fight invaders are known as:

antibodies

Drugs with a wide range of effectiveness against both gram-positive and gram-negative bacteria are called___.Antibiotics that are effective against a few or specific bacteria are called___.

broad spectrum; narrow spectrum

broad-spectrum and bactericidal action (antagonistic with other antibiotics)

carbapenems

broad-spectrum and active against both Gram-negative and -positive; however more effective against Gram-negative bacteria

cephalosporins

As we've learned, the pharmacological action of antibiotics occurs at the cellular level. The effect is either bactericidal or bacteriostatic with each antibiotic group being defined by type or mechanism of action. What are the cellular actions of antibiotics? Mark all that apply.

destroy cellular wall suppress nucleic acid synthesis block respiratory enzymes derange cellular membrane function to interfere with metabolism and protein synthesis

The tetracyclines act by _____ to treat diseases/conditions like ___.

diffusing through bacterial wall to bind to ribosomes interfering with reproduction; Rocky Mountain spotted fever, Mycoplasma pneumoniae, cholera, chlamydia, Lyme disease, and acne

narrow spectrum antibiotics

effective in treating just a few types of bacteria or a specific bacteria.

C. difficile

following treatment with a broad-spectrum antibiotic. This can result in diarrhea or life-threatening colitis

1. Inborn immunity

genetic makeup of an individual, an ethnic group or a species.

Virus

genetic material in a protein coat that replicates/reproduces inside a living cell a virus acts as a parasite

Which of the following vaccines can be administered at birth?

hep B

Immunoglobulins

high concentrations of antibodies for a specific antigen. Blood products derived from plasma

Select all indications for antibiotic prophylaxis.

history of rheumatic fever prior to surgical or dental procedures presence of some prostheses or implants prior to surgical or dental procedures exposure to STD prior to sign of infection neutropenia with fever exposure to anthrax (bioterrorism)

An allergic reaction, or type I hypersensitivity reaction, to a medication may be manifested most often in the following ways ___. Select all that apply.

hives rash anaphylaxis

The most common adverse effect associated with vaccinations is:

localized inflammation

Synthetic Antibiotics

manufactured completely in the lab

Cross resistance

natural ability of a normal organism to remain unaffected by noxious agents in its environment.

What are super infections

new infections that appear during the course of treatment for a primary infection that results when the antimicrobial alters the balance of normal flora within the body.

from mother to fetus or baby or administration of antibody by injection

no match

Fungus

one-celled organism that forms spores and thrives on dead organic matter.

Bacteria

one-celled organism with no nucleus. sensitive to antibiotics

An infection that is present because the immune system cannot fight the normal flora found on the body or in the environment is a/an ________.

opportunistic infection

Ethambutol is an anti-tubercular agent that may cause:

optic neuritis

active against Gram-positive staphylococci and streptococci, Gram-negative neisseria and E. coli, spirochetes, and some anaerobic bacteria

penicillins

Biologics

prevented more morbidity and mortality than all other drugs combined

Antibiotic prophylaxis

prevention of infection complications using antimicrobial therapy. While it is important to avoid misuse and overuse of antibiotics

Macrolides are named for the large size of the chemical compounds and are ______.

primarily bacteriostatic and indicated for treatment of Legionnaires' disease, Chlamydia infections, and atypical respiratory tract infections

National Institutes of healh

recommendations as well as a summary of what is being done so far to combat the development of resistance in bacteria and other microorganisms. *Search for new antibiotics *Stop the use of antibiotics as growth-promoting substances in farm animals *Use the right antibiotic in an infectious situation *Stop unnecessary antibiotic prescriptions *Finish antibiotic prescriptions

The immune system is part of the lymphatic system.

remove foreign substance from blood and lymph combat infectious diseases maintain tissue fluid balance absorb fats.

You should inform patients that ____ may cause tears and urine to become a red-orange color.

rifampin

Lecture 4.1

the immune system and immunity

Live vaccines are composed of living microbes that have been weakened or rendered avirulent; e.g. OPV, rotavirus vaccine, or MMR.

true

Sulfamethoxazole with trimethoprim is first-line treatment for ______. One important point of patient education is to instruct the patient to drink 8-10 glasses of water per day to prevent ____ in the kidneys.

urinary tract infections; crystallization

what infections are treated by anti-infectives?

virus, fungus

Contradictions to vaccinations

*Allergies to a substance in the vaccine or used to make the vaccine. *Receiving corticosteroids, antineoplastics or radiation therapy or immunocompromised - live vaccines *Moderate to severe infection with acute fever - just having a slight fever is not a contraindication *Pregnancy and lactation *Previous anaphylaxis *Concurrent vaccines - interactions

Severe adverse reactions to vaccines

*Anaphylaxis — usually occurs within about 30 minutes if it's going to happen *Guillain-Barré syndrome (ascending paralysis associated with a viral infection) — very rare.

what is to be documented in the medical record

*Date of vaccination *route and site of vaccination *Vaccine type, manufacturer, lot number, and expiration date *Name, address, and title of person administering the vaccine *Delivery of VIS to the appropriate person and the date of VIS publication *Signing of permission to give medication by parent or guardian before administration.

Super Shots

*Pediarix — DTaP, hepatitis B, polio (IPV) *ProQuad — MMR, varicella *Pentacel — DTaP, Hib, polio (IPV).

Adverse affects of Vaccines

*injection site reactions *fever *headache *malaise *nausea *dizziness *muscle and/or joint aches and pains

adult immunization are

*shingles vaccine (Zostavax) - recommended for adults 60 years or older (1 injection) *hepatitis B - health-care workers with exposure to human blood and tissues *BCG vaccine - extremely high-risk individuals (also used to treat bladder cancer) *Influenza (annual) - especially for those at high risk for flu complications *pneumococcal vaccine

International adult immunizations

*yellow fever *hepatitis A (Havrix, VAQTA) *Cholera, typhoid, and plague - may be suggested.

Process of Cell mediated and Humoral Immunity

1.Body recognizes foreign antigen and causes activation of the macrophage 2.Macrophage engulfs, breaks down, and displays (expresses) the antigens on its own exterior and signals a helper T- cell 3.Helper T-cell reads signal and alerts other parts of the immune system to respond 4.B-cell responds and reads the antigen from the surface of the macrophage 5.B-cell activates and produces antibodies specific to the antigen 6.Specific antibodies are released into the body and attach to antigen particles 7.Antibodies send signal to other macrophages and other immune cells to engulf and destroy the antibody 8.Once the number of invaders has dropped significantly and the infection has resolved, the suppressor T-cell signals other cells of the immune system to rest to prevent damage to healthy cells.

People who require Immunization

1.Children (kids with AIDS usually get everything but varicella & MMR — live attenuated viruses) 2.Health care workers 3.Teens and young adults 4.Women of childbearing age (they should get MMR and varicella vaccines no later than 1 month before pregnancy occurs - if a pregnant moms get these vaccinations, the virus is very dangerous to the fetus (teratogenic)) 5.Woman, who are breastfeeding - should not receive until child is weaned 6.Individuals at high risk of morbidity and mortality (sickness/death) from a certain disease; e.g., debilitated and elderly or premature or high-risk infants (current immune disorders or heart or lung disorders) 7.Individuals at high risk for exposure to certain diseases

B lymphocytes

10-15% of the circulating lymphocytes and are the active component of humoral immunity and can differentiate into plasma cells for the production and secretion of antibodies produce daughter lymphocytes that develop into plasma cells activated B cells turn into memory cells that continually produce small amounts of antibody after infection is overcome.

What are the types of immunizing agents?

Active and passive

The only routine immunizations recommended for all normal adults between the ages of 18-65 years are booster doses every 10 years of ____. Mark all that apply.

Adult Diphtheria Adult Tetanus

Cytotoxic T-cells differentiate into plasma cells that produce and secrete antibodies.

False

organs of the lymphatic system

Lymph nodes(lymph glands)-small, bean shaped Thymus-small, located behind the breast bone; T-cells mature here. Spleen-Largest lymphatic organ, size of your fist. located- Upper-left part of the abdomen. Contains WBCs that fight infection or disease. Also helps control the amount of blood in the body that destroys old and damaged blood cells. Bone Marrow-yellow tissue in the center of your bones is responsible for making the white lymphoid lineage cells that are destined to become lymphocytes - the B-cells Lymphocytes- small WBCs, help the body fight disease. 2 main types of lymphocytes: B-cells and T-cells. B-cells make antibodies that attack bacteria and toxins. T-cells help destroy infected or cancerous cells and attack body cells themselves when they have been taken over by microbes or have become cancerous.

National Childhood Vaccine Injury Act of 1986

Vaccination Information Statement (VIS) documents are required for certain mandated vaccinations and recommended for others

Review the CDC immunization schedule for children 18 months-18 years. The second dose of the MMR and varicella vaccines should be given at ____.

ages 4-6 years

T-lymphocytes (cytotoxic T-cells)

along with macrophages directly attack foreign cells and body cells infected with viruses. these do not produce antibodies are the primary cells that provide cell-mediated immunity.

Natural Killer(NK)

also a lymphocyte 5-10% of circulating lymphocytes Attack foreign cells, Virus infected cells, and cancer cells

Antitoxins

antibodies that are produced to attack a specific toxin, so when they're administered, the toxin can be neutralized

Antibiotic

any substance produced by a microorganism that is sent outside its cell to harm or kill another microorganism. made from enhanced natural substances or synthetically-formed substances

2 types of Artificial Immunity (exogenous)

artificial active and artificial passive immunity.

______ occur naturally in the body and can be produced in the laboratory to alter the interaction between the body's immune defenses and cancer cells to boost, direct, or restore the body's ability to fight disease.

biologic therapies

The Food and Drug Administration (FDA) classifies immunizing agents and allergenic extracts as:

biologics

Lymphatic system acts to:

body is able to recognize self and non-self.

A dose given to increase the effectiveness of the original medication is a/an _____.

booster

Standards for adults age 65 yrs, and under

booster doses every 10 years

Semisynthetic Antibiotics

contain at least some of the original microorganism

lymphocytes

create special proteins called antibodies that respond to invading pathogens, abnormal body cells (like cancer), and foreign proteins (like toxins) About 80% of the circulating lymphocytes are T lymphocytes.

Refusal of immunization

cultural, religious, or other reasons (limited access, mistrust of the medical system, limited resources, or lack of health literacy)

Empiric therapy

educated guess for medical therapy based on experience and in the absence of complete or perfect information

Broad spectrum antibiotics

effective in treating a wide range of bacteria - both gram-positive and gram-negative. given before the actual cause of infection

The Advisory Committee on Immunization Practices recommends that children be immunized against how many infectious diseases - excluding hepatitis A in areas of high incidence and HPV.

eight

Natural Immunity (endogenous)

immunity that is genetically determined by species, families, or populations

Decreased or compromised ability of the body to respond to an antigen with an appropriate immune response is termed____

immunodeficiency

Immunosuppressants increase the risk of infections and lymphomas. Many antineoplastic agents produce immunosuppression as a side effect. This is an acquired immunodeficiency, which may be treated with interferon alfa or interleukin-2 that can stimulate production of B cells and killer T cells. These types of drugs are called ____.

immunostimulants

An agent that interferes with the normal reactions of the immune system to an antigen and used in arthritis treatment and organ transplantation to prevent the production of antibodies to foreign antigens is a/an _______.

immunosuppressant

3 types of natural immunity:

inborn, natural active, and natural passive immunity.

What are the common indications for a vaccination? Select all that apply.

initial immunization against childhood diseases passive immunization in illnesses where active immunization is not available passive immunization for those who cannot take active immunizations booster immunization against disease as indicated by age and disease process

__________ are types of cytokines that occur naturally in the body and can also be produced in the laboratory. These cytokines act as immunostimulants and can improve the way a cancer patient's immune system acts against cancer cells.

interferons and interleukins

Artificial Active

long-term immunity that you develop after receiving immunization with a specific agent and develop antibodies to a specific disease process. Purposely introduced antigen to stimulate production of antibodies

2.Natural Active Immunity

more or less permanent by species or results from formation of antibodies after disease processes Disease with production of antibodies (years-lifetime)

Vaccine Adverse Event Reporting System (VAERS)

national surveillance program sponsored by the CDC and the FDA

Which is the type of immunity that is genetically determined by species, families, or populations?

natural immunity

What is the Immune system?

network of cells, tissues, and organs that work together to defend the body against attacks from "foreign" invaders called antigens.

immediate

no match

immunity from immune humans or animals

no match

short term, days to a few months

no match

Passive Agents

older than active agents and are various antitoxins derived from animals. Temporary preventative immunity can be given as artificial passive immunity

Vaccine

preparation containing a suspension of whole or fractionated microorganisms that on administration causes the recipient to form antibodies to a disease. It produces or artificially increases immunity to a disease 95% of kids are immunized

Immunization(Vaccination)

process by which a person is made immune or resistant to an infectious disease

What is Immunity?

produced by the immune response and is the ability to resist infection and disease through activation of a specific defense.

How does the immune system work?

several ways of fighting foreign invaders (antigens). Invading microorganisms and foreign substances cause production of more white blood cells, or lymphocytes

Artificial Passive Immunity

short-term immunity occurring when receiving antibodies for a specific disease from other persons or animals. Exposure to virulent organism with introduction of ready-made antibodies in immune serum

Antigen

substance that is either introduced into the body or produced by the body resulting in the formation of antibodies specific to that antigen.

Bacterial toxins that have been changed to a nontoxic state are_____.Antibodies produced in response to specific toxins and, when administered, have the ability to neutralize these specific toxins for persons at high risk for the disease or condition are_____.

toxoids;antitoxins

3.Natural Passive Immunity

type of immunity (IgM) passed from mother to child, either in utero or in breast milk natural inherent factors protects infants up to 6-12 months after birth

Active agents

usually administered before disease exposure and provide long-term, even permanent, protection. provide artificial active immunity. generally available SC, IM, intranasal, and PO

A preparation of microorganisms that is administered to produce or artificially increase immunity to a particular disease is a/an _____, which is a type of ____ immunity.

vaccine;active