abx pt 2

Question 1

aminoglycosides

Answer 1

used to treat gram-negative aerobic bacilli infections
inhibit protein synthesis
gentamicin, amikacin, neomycin, streptomycin, tobramycin
limited 2/2 side effects

Question 2

gentamicin (Gentak, Garamycin) action

Answer 2

aminoglycoside prototype

inhibits protein synthesis by directly binding to 30S ribosomal subunit

Question 3

gentamicin indications

Answer 3

pseudomonas aeruginosa
e. coli
proteus
klebsiella
enterobacter
penicillin allergies

oral neomycin given as GI surgery prophylaxis

Question 4

gentamicin pharmacokinetics

Answer 4

PO, IM, topical, opthalmic, intrathecal
poor GI absorption, good IM absorption
does not enter CSF
excreted in urine, breast milk

Question 5

gentamicin topical cream

Answer 5

do not apply to large area of skin

risk of systemic absorption and toxicity

Question 6

gentamicin black box warning

Answer 6

can cause fetal harm during pregnancy

potential deafness in fetus

Question 7

gentamicin contraindications

Answer 7

hypersensitivity
neuromuscular disorders
impaired renal fxn
pregnancy category C

Question 8

gentamicin side effects

Answer 8

encephalopathy, seizures, ataxia, neuropathy
hypotension
ototoxicity, tinnitus
n/v/d, weight loss
nephrotoxicity
thrombocytopenia, leukopenia
myasthenia-gravis like syndrome
rash

Question 9

aminoglycoside 2 major toxic effects

Answer 9

ototoxicity

nephrotoxicity

Question 10

gentamicin interactions

Answer 10

NSAIDs, amphoteracin B: risk of nephrotoxicity
cephalosporin, vancomycin, penicillin: enhances effect
neuromuscular blockers: can prolong respiratory paralysis
loop diuretics: ototoxicity
indomethacin: peak/trough levels may rise
heparin is incompatible

Question 11

do aminoglycosides have adverse CNS effects?

Answer 11

yes but only in PO form

topical, IV, IM do not affect CNS

Question 12

gentamicin interventions

Answer 12

monitor for tinnitus, hearing loss
evaluate 8th cranial nerve with audiometry
maintain drug levels in therapeutic range (peak/trough)
do not collect blood in heparinized tube
must not mix with other IV medications/infusions

Question 13

gentamicin pt teaching

Answer 13

report changes in urine
report vision/hearing changes, vertigo, ataxia, seizures, edema
drink fluids

Question 14

lincosamides

Answer 14

only used when less toxic abx fail
limited to situations w known sensitivity
clindamycin prototype

Question 15

clindamycin indications

Answer 15

aerobic gram-positive cocci
anaerobic gram-negative and gram-positive organisms

streptococci, pneumococci, staphylococci

Question 16

clindamycin pharmacokinetics

Answer 16

given IV, IM, PO
metabolized in liver
excreted in bile, urine

Question 17

clindamycin action

Answer 17

binds to bacterial ribosomes to suppress protein synthesis

Question 18

clindamycin IV

Answer 18

for infusion: dilute each 300mg in 50 mL solution; give over 30-60 min

incompatible with ampicillin, barbiturates, calcium gluconate, magnesium sulfate, phenytoin

Question 19

clindamycin PO

Answer 19

do not refrigerate reconstituted oral solution

Question 20

clindamycin IM

Answer 20

do not exceed 600 mg per injection

Question 21

clindamycin contraindications

Answer 21

hypersensitivity (may cause severe skin reaction dress syndrome)
pregnancy
asthma

Question 22

clindamycin black box warning

Answer 22

CDAD

pseudomembranous colitis

Question 23

clindamycin side effects

Answer 23

thrombophlebitis
pseudomembranous colitis
rash
jaundice
thrombocytopenia, leukopenia
fatal gasping syndrome in premature infants from benzyl alcohol in drug

Question 24

clindamycin interactions

Answer 24

neuromuscular blockers: may increase blockade
erythromycin: may block clindamycin action
live virus vaccines: not as effective
cyclosporine: nephrotoxicity

Question 25

clindamycin nursing dx

Answer 25

risk for injury r/t allergic reaction diarrhea r/t drug effects risk for injury r/t possible blood dyscrasias

Question 26

clindamycin interventions

Answer 26

check IV site daily monitor hepatic/renal function monitor CBC do not give opioid antidiarrheals

Question 27

clindamycin pt teaching

Answer 27

take capsule with water to avoid esophageal irritation IM injection may be painful report discomfort at IV site report s/s superinfection, hypersensitivity do NOT self treat diarrhea; may mask sx of colitis

Question 28

what is the most serious adverse reaction of clindamycin?

Answer 28

pseudomembranous colitis

Question 29

macrolides

Answer 29

molecules with large ring lactones | erythromycin, azithromycin

Question 30

erythromycin indications

Answer 30

``` legionnaire disease, diptheria, chlamydia streptococcal infections prevents eye infections in neonates pertussis prophylaxis for endocarditis PCN allergy ```

Question 31

erythromycin pharmacokinetics

Answer 31

absorbed Gi metabolized liver excreted urine, bile

Question 32

erythromycin PO

Answer 32

coated tablets or encapsulated pellets cause less GI distress protect from moisture, excessive heat

Question 33

erythromycin IV

Answer 33

only in severe infections when pt can't tolerate PO

Question 34

erythromycin action

Answer 34

inhibits bacterial protein synthesis by binding to 50S subunit of ribosome bactericidal in large doses bacteriostatic

Question 35

erythromycin contraindications

Answer 35

``` hypersensitivity hepatic impairment CDAD QT interval prolongations hypokalemia, hypomagnesia ```

Question 36

erythromycin and pregnancy

Answer 36

``` category B (safe if necessary) lactation may cause superinfection in infants ```

Question 37

erythromycin side effects

Answer 37

``` GI distress, CDAD ventricular dysrhythmias reversible ototoxicity superinfection rash abnormal thinking/emotions ```

Question 38

erythromycin interactions

Answer 38

clindamycin, plavix: decreases levels in blood digoxin, carbamazepine, warfarin, simvastatin, theophylline: increases blood levels verapamil, azole antifungals, diltiazem: inhibit CYP3A4 enzyme and increase erythromycin levels hormonal contraceptives may not be as effective

Question 39

erythromycin interventions

Answer 39

decreased dose may stop GI symptoms monitor for QT interval prolongation monitor PT, INR report s/s ototoxicity, superinfection, GI reactions

Question 40

erythromycin pt teaching

Answer 40

take 2 hours before or 2 hours after eating take with food if GI upset occurs do not take with fruit juice report: palpitations, fainting, hearing loss, vertigo, tinnitus, diarrhea, mouth pain, vaginal discomfort

Question 41

grapefruit juice will ____ the serum concentration of erythromycin

Answer 41

increase

Question 42

tetracyclines

Answer 42

bacteriostatic broad spectrum; affect gram positive and gram negative bacteria many resistant organisms

Question 43

tetracycline indications

Answer 43

``` acne rickets chlamydia pneumonia lyme disease GI helicobacter infections ```

Question 44

tetracycline pharmacokinetics

Answer 44

given PO available IV, IM if PO is not tolerated excreted in urine

Question 45

tetracycline action

Answer 45

inhibits/slows growth of bacteria by preventing protein synthesis

Question 46

in renal failure pts, _____ is safer than tetracycline

Answer 46

doxycycline

Question 47

tetracycline contraindications

Answer 47

allergy pregnancy (category D) renal/hepatic disease

Question 48

tetracycline side effects

Answer 48

diplopia, headache GI upset, ulcers, psuedomembranous colitis yellow/brown tooth photosensitivity, superinfection suppression of long bone growth in premature infants

Question 49

tetracycline interactions

Answer 49

calcium supplement, iron supplement, magnesium laxatives, antacids: reduces absorption of tetracycline oral contraceptive efficacy may be decreased may increase digoxin toxicity

Question 50

tetracycline interventions

Answer 50

decrease dose/give with nondairy foods if GI sx look for s/s liver damage, superinfection, lymphadenopathy, facial swelling check expiration date

Question 51

tetracycline pt teaching

Answer 51

report immediately to provider if pregnant report: jaundice, abd pain, mouth pain, dysphagia, vaginal irritation, bloody stools do not give to children <8 y/o

Question 52

fluoroquinolones

Answer 52

synthetic, broad spectrum abx bactericidal ciprofloxacin, levaquin

Question 53

cipro indications

Answer 53

wide range of infections: enterobacter, proteus, e.coli, k. pneumonia, group D streptococci, staph. aureus ``` UTI/pyelonephritis intra-abdominal infections severe resp infections joint, skin infections typhoid prevent anthrax ```

Question 54

cipro pharmacokinetics

Answer 54

PO, IV, IM absorbed GI metabolized liver excreted in urine, feces

Question 55

cipro IV

Answer 55

infuse slowly incompatible with unasyn, azithromycin, cefepime

Question 56

cipro contraindications

Answer 56

``` CNS disorders (seizures) GI disorders renal impairment warfarin therapy myasthenia gravis pregnancy/children ```

Question 57

cipro adverse effects

Answer 57

``` confusion, seizures, ICP pseudomembranous colitis, CDAD crystalluria neutropenia, thrombocytopenia achilles tendon rupture photosensitivity ```

Question 58

cipro interactions

Answer 58

antacids, iron, calcium, sucralfate: decrease absorption theophylline: increases levels and risk of CNS symptoms warfarin: increases warfarin levels erythromycin, some antipsychotics, antidepressants: torsade de pointes antidiabetic meds: hypoglycemia

Question 59

cipro interventions

Answer 59

monitor for tendon pain! monitor for s/s: aortic aneurysm, SOB, dysphagia, peripheral neuropathy, hypoglycemia, hepatitis monitor GI symptoms

Question 60

cipro pt teaching

Answer 60

``` 1500-2000mL/daily to reduce crystals in urine report tendon pain immediately avoid driving avoid caffeine photosensitivity is increased ```