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pharm 140 > abx pt 2 > Flashcards

abx pt 2 Flashcards

1
Q

aminoglycosides

A

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

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2
Q

gentamicin (Gentak, Garamycin) action

A

aminoglycoside prototype

inhibits protein synthesis by directly binding to 30S ribosomal subunit

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3
Q

gentamicin indications

A 
pseudomonas aeruginosa
e. coli
proteus
klebsiella
enterobacter
penicillin allergies

oral neomycin given as GI surgery prophylaxis

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4
Q

gentamicin pharmacokinetics

A

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

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5
Q

gentamicin topical cream

A

do not apply to large area of skin

risk of systemic absorption and toxicity

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6
Q

gentamicin black box warning

A

can cause fetal harm during pregnancy

potential deafness in fetus

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7
Q

gentamicin contraindications

A

hypersensitivity
neuromuscular disorders
impaired renal fxn
pregnancy category C

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8
Q

gentamicin side effects

A 
encephalopathy, seizures, ataxia, neuropathy
hypotension
ototoxicity, tinnitus
n/v/d, weight loss
nephrotoxicity
thrombocytopenia, leukopenia
myasthenia-gravis like syndrome
rash
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9
Q

aminoglycoside 2 major toxic effects

A

ototoxicity

nephrotoxicity

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10
Q

gentamicin interactions

A

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

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11
Q

do aminoglycosides have adverse CNS effects?

A

yes but only in PO form

topical, IV, IM do not affect CNS

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12
Q

gentamicin interventions

A

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

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13
Q

gentamicin pt teaching

A

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

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14
Q

lincosamides

A

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

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15
Q

clindamycin indications

A

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

streptococci, pneumococci, staphylococci

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16
Q

clindamycin pharmacokinetics

A

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

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17
Q

clindamycin action

A

binds to bacterial ribosomes to suppress protein synthesis

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18
Q

clindamycin IV

A

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

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

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19
Q

clindamycin PO

A

do not refrigerate reconstituted oral solution

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20
Q

clindamycin IM

A

do not exceed 600 mg per injection

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21
Q

clindamycin contraindications

A

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

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22
Q

clindamycin black box warning

A

CDAD

pseudomembranous colitis

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23
Q

clindamycin side effects

A 
thrombophlebitis
pseudomembranous colitis
rash
jaundice
thrombocytopenia, leukopenia
fatal gasping syndrome in premature infants from benzyl alcohol in drug
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24
Q

clindamycin interactions

A

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

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25
Q

clindamycin nursing dx

A

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

26
Q

clindamycin interventions

A

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

27
Q

clindamycin pt teaching

A

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

28
Q

what is the most serious adverse reaction of clindamycin?

A

pseudomembranous colitis

29
Q

macrolides

A

molecules with large ring lactones

erythromycin, azithromycin

30
Q

erythromycin indications

A 
legionnaire disease, diptheria, chlamydia
streptococcal infections
prevents eye infections in neonates
pertussis
prophylaxis for endocarditis
PCN allergy
31
Q

erythromycin pharmacokinetics

A

absorbed Gi
metabolized liver
excreted urine, bile

32
Q

erythromycin PO

A

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

33
Q

erythromycin IV

A

only in severe infections when pt can’t tolerate PO

34
Q

erythromycin action

A

inhibits bacterial protein synthesis by binding to 50S subunit of ribosome

bactericidal in large doses
bacteriostatic

35
Q

erythromycin contraindications

A 
hypersensitivity
hepatic impairment
CDAD
QT interval prolongations
hypokalemia, hypomagnesia
36
Q

erythromycin and pregnancy

A 
category B (safe if necessary)
lactation may cause superinfection in infants
37
Q

erythromycin side effects

A 
GI distress, CDAD
ventricular dysrhythmias
reversible ototoxicity
superinfection
rash
abnormal thinking/emotions
38
Q

erythromycin interactions

A

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

39
Q

erythromycin interventions

A

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

40
Q

erythromycin pt teaching

A

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

41
Q

grapefruit juice will ____ the serum concentration of erythromycin

A

increase

42
Q

tetracyclines

A

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

43
Q

tetracycline indications

A 
acne
rickets
chlamydia
pneumonia
lyme disease
GI helicobacter infections
44
Q

tetracycline pharmacokinetics

A

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

45
Q

tetracycline action

A

inhibits/slows growth of bacteria by preventing protein synthesis

46
Q

in renal failure pts, _____ is safer than tetracycline

A

doxycycline

47
Q

tetracycline contraindications

A

allergy
pregnancy (category D)
renal/hepatic disease

48
Q

tetracycline side effects

A

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

49
Q

tetracycline interactions

A

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

50
Q

tetracycline interventions

A

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

51
Q

tetracycline pt teaching

A

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

52
Q

fluoroquinolones

A

synthetic, broad spectrum abx
bactericidal
ciprofloxacin, levaquin

53
Q

cipro indications

A

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
54
Q

cipro pharmacokinetics

A

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

55
Q

cipro IV

A

infuse slowly

incompatible with unasyn, azithromycin, cefepime

56
Q

cipro contraindications

A 
CNS disorders (seizures)
GI disorders
renal impairment
warfarin therapy
myasthenia gravis
pregnancy/children
57
Q

cipro adverse effects

A 
confusion, seizures, ICP
pseudomembranous colitis, CDAD
crystalluria
neutropenia, thrombocytopenia
achilles tendon rupture
photosensitivity
58
Q

cipro interactions

A

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

59
Q

cipro interventions

A

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

60
Q

cipro pt teaching

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

pharm 140 (18 decks)

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