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    《ISPN学习》总第506期
    《ISPN学习》总第505期
     
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    《ISPN学习》总第508期
    日期:2019-07-10 17:48:55    
    《ISPN学习》2019年07月10日总第508期
     
     
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    ISPN  Review        
    Characteristics of Antimicrobial Drugs 抗微生物药的特点
    Terms and Concepts术语与概念
    Several terms are used to describe these drugs. Anti-infective and antimicrobial include antibacterial, antiviral, and antifungal drugs; antibacterial and antibiotic refer to drugs used in bacterial infections and are often used interchangeably. Additional terms for antibacterial drugs include broad spectrum, for those effective against several groups of microorganisms, and narrow spectrum, for those effective against a few groups. The action of an antibacterial drug is usually described as bactericidal (kills the microorganism) or bacteriostatic (inhibits growth of the microorganism). Whether a drug is bactericidal or bacteriostatic often depends on its concentration at the infection site and the susceptibility of the microorganism to the drug.
     
    有几个术语被用来描述这些药物:抗感染和抗微生物药包括抗菌药、抗病毒药和抗真菌药;抗菌药和抗生素指的是用于治疗细菌性感染的药物,两个名称常常互用。有关抗菌药的其他术语包括广谱(对多种细菌治疗有效)和窄谱(只对几种细菌有效)抗生素。通常用于说明抗菌药作用的术语为杀菌(杀死细菌)或抑菌(抑制细菌的发育)。药物是杀菌还是抑菌,常常取决于药物在感染部位的浓度和细菌对该药物的敏感性。
     
    Mechanisms of Action 作用机制
    Most antimicrobial drugs act on a specific target in the infecting organism. Almost any structure unique to infecting organism, such as proteins or nucleic acids, can be a target for antibiotics. Specific mechanisms of action of antimicrobial drugs include the following:
     
    多数抗微生物药作用于感染菌的特定靶标。感染菌独有的任何结构,如蛋白质或核酸,几乎都可以是抗生素的靶标。抗微生物药作用的特殊机制包括:
     
    ■ Inhibition of bacterial cell wall synthesis or activation of enzymes that disrupt bacterial cell walls (e.g., penicillins, cephalosporins, vancomycin)
     
    抑制细菌细胞壁合成或激活瓦解细菌细胞壁的酶(如,青霉素、先锋霉素、万古霉素)
     
    ■ Inhibition of protein synthesis by bacteria or production of abnormal bacterial proteins (e.g., aminoglycosides, clindamycin, macrolides, ketolides, tetracyclines). These drugs bind irreversibly to bacterial ribosomes, intracellular structures that synthesize proteins. When antimicrobial drugs are bound to the ribosomes, bacteria cannot synthesize the proteins necessary for cell walls and other structures.
     
    抑制细菌蛋白质合成或异常细菌蛋白质的产生(如,氨基糖苷类,克林霉素,大环内酯类,酮内酯,四环素类)。这些药物不可逆地结合细菌核糖体,后者为合成蛋白质的细胞内结构。
     
    ■ Disruption of microbial cell membranes (e.g., antifungals)
     
    瓦解微生物细腻膜(如抗真菌药)
     
    ■ Inhibition of organism reproduction by interfering with nucleic acid synthesis (e.g., fluoroquinolones, rifampin, anti–acquired immunodeficiency syndrome antivirals)
     
    通过干扰核酸合成抑制生物繁殖(如,氟喹诺酮类,利福平,抗爱滋病病毒药)
     
    ■ Inhibition of cell metabolism and growth (e.g., sulfonamides, trimethoprim)
     
    抑制细胞代谢和生长(如磺胺类药、甲氧苄啶)
     
    Indications for Use 适应症
    Antimicrobial drugs are used to treat and prevent infections. Because laboratory tests (except Gram’s stain and a rapid test for group A streptococci) to identify causative organisms usually take 24 hours or longer, empiric therapy against the most likely pathogens is often begun. After organisms are identified, more specific therapy is instituted. Prophylactic therapy is recommended to prevent the following:
     
    抗菌药用于治疗和预防感染。鉴于化验试验(革兰氏染色试验和A型链球菌快速试验除外)确认致病菌通常需要24小时或更久,起始治疗通常是先凭经验治疗最可能病原体。在微生物得到确认后,再开始特定的疗法。对于下列感染的预防,通常采取预防疗法:
     
    ■ Group A streptococcal infections and possibly rheumatic fever, rheumatic heart disease, and glomerulonephritis. Penicillin is commonly used.
     
    A型链球菌感染和可能的风湿热、风湿性以及病及肾小球肾炎。建议使用青霉素。
     
    ■ Bacterial endocarditis in patients with cardiac valvular disease who are having dental, surgical, or other invasive procedures. Amoxicillin or ampicillin, with an aminoglycoside, is usually recommended for at-risk persons undergoing certain types of procedures.
     
    有心脏及瓣膜病、正进行牙科、外科或其他侵入性操作的细菌性心内膜炎患者。对接受特定类型操作的风险患者通常建议使用阿莫西林或氨苄西林加氨基葡糖苷。
     
    ■ Tuberculosis in patients with latent tuberculosis infection.
     
    潜伏结核感染患者的结构病。
     
    ■ Perioperative infections in high-risk patients (e.g., those whose resistance to infection is lowered because of age, poor nutrition, disease, or drugs) and for high-risk surgical procedures (e.g., cardiac or GI surgery, certain orthopedic procedures, organ transplants)
     
    高危病人围手术期感染(如,因年龄、营养不良、疾病或药物而引起抗感染性下降的患者)及高危性手术操作(如心脏或GI手术、某些外科矫形手术、器官移植等)。
     
    ■ Sexually transmitted diseases (e.g., gonorrhea, syphilis, chlamydial infections) after exposure has occurred
     
    暴露无遗后出现的性传病(发淋病、梅毒、衣原体感染)
     
    ■ Recurrent urinary tract infections in premenopausal, sexually active women. A single dose of a fluoroquinolone or trimethoprim-sulfamethoxazole for two doses, taken after sexual intercourse, is often effective.
     
    绝经前性生活活跃妇女的复发性泌尿道感染。单剂氟喹诺酮或甲氧苄啶磺胺甲异恶唑合剂,共2 剂,性交后使用,通常有效。
     
     
    Vocabulary for Today    

    antimicrobial – a. n. 抗菌的,抗菌药
    broad spectrum – 广谱
    narrow spectrum – 窄谱
    bactericidal – a. n. 杀菌的
    bacteriostatic – a. n. 细菌抑制的,抑菌药
    cephalosporin – n. 头孢菌素
    vancomycin – n. 万古霉素
    clindamycin – n. 克林霉素
    macrolides – n. 大环内酯类
    ketolides – n. 酮内酯
    tetracycline – n. 四环素
    ribosome – n. 核糖体
    rifampin – n. 利福平
    amoxicillin – n. 阿莫西林
    ampicillin – n. 氨卞西林
     
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    Video            
    Antibacterial Agents
     
    Test                 
    1. When an anti-infective agent is said to be no longer effective for a patient, the patient has developed:
    A. Immunity
    B. Tolerance
    C. Non-responsiveness
    D. Resistance
    2. A middle-aged woman came to the ER and complains of ringing in the ears, paresthesias of the extremities, and erythema of the back. She also noticed that she had decreased urine output. What history of drug intake should the nurse ask?
    A. Oral contraceptive pills (OCPs)
    B. Antifungals
    C. Vancomycin
    D. Trimethoprim-sulfamethoxazole
     
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    本期ISPN Review答案
    1. D. Resistance. It occurs when the cells of the invading pathogens no longer respond to the drug.
    2. C. Vancomycin. Its toxicity includes ototoxicity, renal failure, and red man syndrome characterized by erythema on the neck and back, paresthesia, chills, severe hypotension, and fever.
     




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