 Hi everyone, it's Leah, your lead course instructor here at Advanced E-Clinical Training. And so I just want to welcome you back to our Pharmacology series here. Today we're going to go over antibiotics. So of course by now I'm sure we all know what antibiotics are. We've probably all been on an antibiotic before, maybe once or twice or more. So antibiotics are medications that fight bacterial infections in both humans and animals. And they work by either killing the bacteria or by making the bacteria very hard to grow and to multiply. Antibiotics can be taken in several different ways. Of course, orally, they can be taken, you know, capsule pills, capsules or pills or liquids. Topically, this might be a cream or a spray or an ointment that you put on your skin. And then that antibiotic is absorbed transdermally through the skin. It could also be an eye ointment, an eye drop, or an ear drop. And then also, of course, antibiotics can also be used IV or IM. So IV meaning intravenously and IM meaning intramuscularly. And that both of those routes that IV and IM are usually used for more serious types of infections. So the different types of antibiotics, the major classes of antibiotics here include the amino glycosides, the cephalosporins, the penicillins and the penicillin-resistant drugs. We also have the sulfanomides, the tetracycline, the carbapenems, and the fluoroquinolobones. So first, we'll start by talking about the amino glycosides. So this group or this class of antibiotic is used to treat infections caused by gram-negative aerobic bacilli. And so amino glycosides are also effective against other bacteria, including this astaphylococci and mycobacterium tuberculosis. And they are often used in combination with other antibiotics as well. So examples of some common names of amino glycosides. We have Gentamiasin, Tobramiasin, Amakasin, Streptomiasin, Anomiasin as well. And here are the pharmacokinetics for the amino glycosides. But I do not want you to have to memorize this. You don't have to memorize the sparpokinetics for these antibiotics. I put this in the presentation because I thought it might be interesting to you and that, you know, it helps supplement your learning. But under no circumstances do I want you to have to remember any of these former kinetics for any of these antibiotics. This is just to really supplement your learning. So again, the amino glycosides could be given IM or IV. The onset is rapid. The peak of the medication is between 30 and 90 minutes. You know, the half-life is between two and three hours. It's metabolized through the liver and then excreted by the kidneys. Here are some contraindications and some adverse effects for the amino glycosides. I'm not going to read all of these to you because you can read on your own. But just some things to definitely consider that I want to point out. Of course, if you have a known allergy to an amino glycoside, you're not going to be prescribed one for another infection. Also lactation, so this type of antibiotic is excreted in the breast milk and then can potentially cause serious effects in the infant. So you really want to be aware of that, especially as a medical assistant and you are taking a medical history down or you're taking the patient's medication list. So if they are female and they are currently breastfeeding, definitely should not be taking an amino glycoside. Some adverse effects, renal failure is a big one. The amino glycosides tend to have more of an effect on the central nervous system. So deafness, vestibular paralysis, confusion, weakness. Definitely GI symptoms, nausea, vomiting, diarrhea, weight loss. So all things to be considered here. Moving on to the carbapenems. So this is a relatively new class of broad spectrum antibiotics effective against gram-positive and gram-negative bacteria. Broad spectrum meaning that this class of antibiotics can treat a broad spectrum or a wide variety of different types of bacteria. So some indications for this medication would include serious intra-abdominal infections, urinary tract infections, skin infections, any type of bone infection, ganalogical infection, and especially infections that are resistant to other antibiotics. And so infections, so the carbapenems will be effective or susceptible against these strains of bacteria. So that is what's important to really know about antibiotics is that a lot of these classes of antibiotics that will go over can treat an abdominal infection or a UTI or a skin infection. What's important is, is that antibiotic susceptible to that type of bacteria? So some common names here of the carbapenems. You have the brand name here, the generic name here. I've mostly only seen the generic names given, meropenem is a very popular one given. This dorapenem as well is pretty commonly given as well. Just a side note that any, when we're talking about pharmacology brand names are always going to start with a capital letter and then the generic names are always going to begin with a lowercase letter. Again, the pharmaconetics here, I don't want you to memorize this. This is just to supplement your learning. Again, these medications can be given IM or IV. It has a rapid onset because it's given IM or IV. And then the half length is around four hours and again it's greeted through the kidneys. So some contraindications and adverse effects of the carbapenems. So you'll start to see some definite trends. So contraindicated of course lactation. We don't know whether this drug can cross into the breast milk or not, but probably just to err on the safe side, we're not going to give this type of medication to somebody who is breastfeeding. So the dorapenem is not recommended for use in patients younger than 18 years of age. Adverse effects, so GI, so pseudomembrous colitis, C-diff, diarrhea, nausea, vomiting, super infections. Now, a lot of times with these antibiotics that are what we call heavy hitters, they are doing what they're supposed to do. They're killing the bacteria that they were made to kill. And so you get better. But at the same time, then it's also killing the good flora or the good bacteria in your GI tract, which then can cause a C-diff infection. And when our patient has a C-diff infection, they are usually have a lot of, a lot of loose stool, very, has a very distinct smell to it. Once you know the smell of C-diff, you'll never forget it. You'll always know what that is exactly once you smell it. So something to consider. Moving on to the cephalosporins. So this class of antibiotics was first introduced in the 1960s, and there are currently four generations of the cephalosporins, each with a specific spectrum of activity. These drugs are like penicillin and structure and their activity. And again, these cephalosporins can treat bone infections, ear infections, skin infections, upper respiratory tract infections, urinary tract infections. And remember what I said that with the antibiotics, what's most important is that antibiotic susceptible to that bacteria. And how we, how we find that out is by doing a culture. So if your patient or we think they have pneumonia, yes, that can be diagnosed by an X-ray, but we want to know what kind of bacteria is causing that pneumonia, so we can give them the right antibiotics. So we'll do a sputum culture. So your patient will spit into a cup, that sample is then sent to the lab and they'll do, they'll test what type of bacteria. Same with a urinary tract infection, that urine sample will be tested to see what type of bacteria is in that urine. So we know exactly what type of bacteria to, what type of antibiotic to give to that patient to treat that specific bacteria. Seemed for a surgical site infection, we're going to do a WIM culture, which is a long Q-tip, and then we take a sample of that. Tissue or, you know, the drainage from within that surgical wound and we send that off to the lab to be tested to find out what bacteria is growing. So that's how we, that's how we find out. So some common names here of the cephalosporins, first-generation cephalozolein, cephalexin, those are very common ones that I see given very often. Second generations of the cephalosporins, cepheroxyne is a very common one. Third generation, the sephutriaxome, is very commonly given. And then the fourth generation, cephapine. But these are all cephalosporins here. Again, we have the pharma kinetics, not, you do not need to memorize this. Again, this is just to supplement your learning. So you can go ahead and look over that if you'd like. And then moving on again to the contraindications and the adverse effects. Like I said before, you're going to start to see some patterns here. Antibiotics all seem to, you know, cause the same kind of adverse effects, especially when the GI area, super infections, and especially you want to be very careful about antibiotics with pregnant women. So when you're out there working in the field, if you happen to have a patient who's pregnant and they have, you know, and you're doing their med history or their medication less, you want to make sure that they're not taking a cephalosporin, especially cause it may harm their fetus or pass through the breast milk. The fluoroquinololins. So these are relatively new synthetic class of antibiotics, which again have a broad spectrum of activity. So they can kill a broad spectrum of bacteria. But they are indicated for most following conditions. So specifically typhoid fever, anthrax, are the two biggest bacterial gastroenteritis. And again, different UTI infections, bacterial infections in the chest as well, pneumonia. Some common names here, again, here to the left are the brand names. So Avalox, Cipro, Leviquin, those are very common ones that we see given today, again, on the right side or the generic names. And here are the pharma kinetics for the fluoroquinolins. But again, you do not need to memorize this. And then some contraindications and adverse effects. Here again, we see the same patterns with the pregnancy lactation, the GI issues. One I think is pretty interesting here is the photosensitivity to sunlight and ultraviolet light. So definitely that is a good teaching moment for you. If you happen to see that one of your patients is, you know, taking, you know, Cipro and, you know, it's the summertime. You want to just really let them know, hey, listen, really should stay out of the sun. You know, your skin is going to be extra sensitive to the sunlight. You can develop a rash and burn very easily. So something just to keep in mind there. Now, moving on to penicillin and the penicillin-resistant antibiotic. So of course, penicillin was the very first antibiotic introduced for clinical use. And so since then, there have been various modifications to address the resistance strains of penicillin and to decrease the drug adverse effects. So the penicillin-resistant antibiotics were then developed to address the bacteria that then became resistance to penicillin. So specifically, these penicillin and the penicillin-resistant antibiotics, you know, contradental abscesses, ear infections, gonorrhea, you know, endocarditis, which is infection in the heart or an infection on the heart valve. And penicillin is also used to treat meningococcal meningitis if given at high doses. So specifically, penicillin with the immunopenicillins, they are used mostly for grand positive bacteria and some grand-negative bacteria, such as E. coli. Some of the generic name we've probably all heard of amoxicillin and ampicillin. The anti-pseudomonal penicillin, so their spectrum of activity is for most grand positive and grand-negative bacteria, anti-pseudomonal and anti-protozoal activity. And that's usually given with a beta-laptomase. So a generic name is Pipericillin. Moving on to the beta-laptomase inhibitors, which is also a penicillin, so they are affected against most grand positive and grand-negative bacteria. And especially those that produce a beta-laptomase, such as like enterococcus or staphylococcus. So the generic names of the amoxicillin collaborate and that is also known as Augmentin. The ampicillin, cell-bactam, unicin is the brand name. And then the Pipericillin, tazobactam, or otherwise known as Zocin. So unicin and Zocin are given IT. You see this in the hospital very often. Augmentin is given orally. And it's mostly seen more outside of the hospital. So keeping with the penicillins, the natural penicillin is effective against most grand-positive bacteria. And they have a limited number of gram and they're effective against a limited number of gram-negative bacteria. Generic name here, penicillin V or penicillin G. And again, staying with penicillins, the penicillin-resistant penicillins. So their spectrum of activity include their effective against gram-positive and gram-negative bacteria. And they're naturally resistant to beta-lactamase. So some generic names, naphycylin, oxycylin. They're two biggest ones, the most common that I've seen given in the hospital, mostly given IV. These medications are used for a very serious serious infections. And again, the contraindications and the adverse effects you see here again once again with the pregnancy and lactation and then, you know, the GI issues that can that can happen. So sulfonamides. So sulfonamides are drugs that inhibit folic acid synthesis. So it's really important for you to understand that sulfonamides are indicated. Well, before I do that, sulfonamides is a group of medications. So again, they inhibit folic acid synthesis, but there are antibiotics, sophomol, and then there are non-antibiotic sulfonamides. So something just to keep in mind, so there, like I said, are several non-antibiotic sulfonamides that have been developed to treat conditions such as diabetes and also for pain relief and some antimicrobial sulfa drug streets, some autoimmune disorders such as ulcerative colitis and rheumatoid arthritis. So I just wanted to point that out to you. I think that's pretty interesting. But some common names for the antibiotic form of the sulfonamides, Bactrim, that's a very common one, the Bactrim DS as well, Ceptra DS, and then the generic name is the same for these brand names here. Pharmacokinetics, again, this is just a supplementary learning. You don't have to memorize this. And then the contraindications and the adverse effects are, again, very, very similar to the ones all previously with the other classes of antibiotics as well. Moving on to the tetracycloins. So this is a group of broad spectrum antibiotics that have a common basic structure and are either isolated directly from several species of streptomyce bacteria or produced semi-synthetically from those isolated compounds. And tetracycloins are indicated for the following medical conditions. So UTIs lymph nodes also to treat Lyme disease, malaria, and severe acne. And then also for sexually transmitted diseases such as syphilis, gonorrhea, and chlamydia. So here are some of the brand names you can see here on the left. I recognize them most and are most familiar with the generic names of these tetracycloins, such as doxycycline, minocycline, and then the tetracycline as well. The pharmacokinetics, here you can take a look at that if you like, just to supplement your learning for the tetracycline. And then again, here are the contraindications and the adverse effects. So again, with these antibiotics, what's most important for you to know right now is just to familiarize yourself with the different names of the medications, of the antibiotics, and the classes that they belong to, of the antibiotics. And then I would maybe just memorize or remember, you know, a certain adverse effect or contraindications contraindication for each of those classes of antibiotics. And then maybe think about a teaching moment, attach a teaching moment to that. So you know when you are working in the field, if your patient is taking Cipro, that they are likely to be photosensitive to the sun. So you want to let them know and teach them that you need to stay out of the sun while you're taking Cipro. But otherwise, again, I don't want you to spend time memorizing the pharma kinetics because that's not important right now. So if you have any questions about this or you need any clarification, you know that you can always email me or you can set up time to meet with me during office hours. But thank you all for listening and I'll see you all again soon.