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bacterial pharyngitis
Pathophysiology
not well defined-may have an alteration in host immunity, bacteria of the oropharynx may migrate to cause an infection
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Treatment
Amoxicillin
PK/PD/PG: rapid absorption w or w/o food, excreted in urine 60% unchanged, time to peak 1 hr, 20% protein binding, time-dependent, posti-abx effect
H/MOA: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
AEs: n/v, diarrhea, headache, Vulvovaginal infection
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D: f pt has already taken amoxicillin, hx of recurrent infection unresponsive to amoxicillin should recieve high- dose Augmentin
Warnings: Serious hypersensitivity reactions, such as anaphylaxis and Stevens-Johnson syndrome, to amoxicillin or other beta-lactam antibiotics (eg, penicillins, cephalosporins); avoid use in pts with mononucleosis; c.diff infections
Interactions: can be taken with or without food; concurrent use with oral contraceptives can reduce effectiveness; TCAs; live typhoid and cholera vaccines have decreased effectiveness
Special Pop: No adj for hepatic impariment; DNU CrCl <30; Geriatric: watch for renal fxn; pediatrics use specified dosing adjustments; Risk B in pregnancy
Education: Drug may decrease effectiveness of oral contraceptives with concurrent use. Recommend additional form of birth control. This drug may cause diarrhea, nausea, vomiting, or rash.
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Monitoring: CBC, renal fxn, resolution of infection
acute otitis media
Pathophysiology
Follows a viral upper respiratory tract infection that impairs the mucociliary apparatus and causes Eustachian tube dysfunction in the middle ear-space becomes blocked with fluid and bacteria from nasopharynx are not cleared in this space
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Diagnositics
Peds group: middle ear effusion, moderate-to-severe bulging of the tympanic membrane or new onset otorrhea not due to acute otitis externa or (2) mild bulging of the tympanic membrane and onset of ear pain within the last 48 hours or intense erythema of the tympanic membrane
Amoxicillin
PK/PD/PG: ~20% bound, t1/2 61.3 minutes ER 90 min).
H: MOA: inhibits bacterial cell wall synthesis by binding to one or more of the penicillin- binding proteins which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis.
Adverse drug reactions: headache, diarrhea, nausea, vomiting
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M: infection resolution, s/sx improvement (assess at beginning of therapy and throughout), anaphylaxis at first dose
D : if pt has already taken amoxicillin, has ppurulent conjunctivitis or hx of recurrent infection unresponsibe to amoxicillin should recieve high- dose Augmentin
W: warnings and contraindications: serious hypersensitivity,
superinfection: prolonged use may result in fungal or bacterial superinfection
I: Interactions: IR: can be taken with/ w/o food ER: food decreases rate but not extent of absorption
S: renal adjustments are needed, no hepatic adjustments needed, special dosing for pediatrics.
Education: side effects includ upset stomach. diarrhea, headache. Can be taken w/ wo food. Stoop taking if you have s/sx of an allergic rxn, unexplained bruising or bleding, fevers or chills
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