Anti Biotics

Question 1

Adverse reactions

Answer 1

-hypersensitivity: Benadryl, corticosteroids, epinephrine
-cross sensitivity
-organ toxicity: liver, kidneys, CNS, GI
-hematotoxicity: causes aplastic anemia

Question 2

Beta Lactam inhibitor

Answer 2

-protects PCN from destruction
-extends PCN’s spectrum of efficacy

Question 3

Penicillin (beta lactamase)

Answer 3

-narrrow: penicillin G (IV/IM)
-broad: amoxicillin (PO)
-bac infection (tissue, resp, GI, GU)
-contraindications: hypersensitivity, cross sensitive cephalosporins

Question 4

Cephalosporins (beta lactam)

Answer 4

-cep/cef
-AE: GI upset, superinfection, colitis, thrombocytopenia
-Antabuse with alcohol, furosemide increase nephrotoxicity
-full dose, report PCN allergy and diarrhea, monitor glucose
-cefazolin (Ancef)

Question 5

Carbapenems (beta lactam)

Answer 5

-penem
-bone, joint, skin, tissue infections
-imipenem (cilastatin)

Question 6

Monobactams (beta lactam)

Answer 6

-E. Coli, klebsiella, pseudomonas; mod-sev systemic infections and UTI
-AE: same as other beta lactams, localized thrombophlebitis

Question 7

Aminoglycosides

Answer 7

-NEPHROTIXICITY & OTOTOXICITY!!!!!!***
-serious systemic infections
-micin/mycin/amikacin (gentamicin)
-monitor for tox no longer than 10 days
-AE: hypersensitivity, intense neuro blockade
-drug selection, monitor, treatment 10 days or less

Question 8

Reducing Aminoglycoside toxicity

Answer 8

-identify high risk pt (high NSAID)
-keep hydrated
-caution with diuretics (low urine, high BUN/Cr)
-no longer than 10 days
-detect AE early and reduce dosage or D/C medication

Question 9

Aminoglycosides peak and trough

Answer 9

-Peak: 30 minutes after administration
-trough: right before next dose
-draw 30 mins after peak

Question 10

Fluoroquinolones/Quinolones

Answer 10

-floxacin (ciprofloxacin)
-good PO absorb (reduce with antacids)
-BBW: tendon rupture/tendinitis, peripheral neuropathy, CNS/Cardiac/Derm reactions
-contraindicated: hypersensitivity, pregnant, kids, pt with MG

Question 11

Fluoroquinlolones/Quinolones AE

Answer 11

-CNS: HA, dizzy, insomnia, confuse, depress
-GI: constipation, diarrhea, N/V, superinfection (thrush)
-cardiac: prolonged QT
-integumentary: photosensitive

Question 12

Tetracyclines

Answer 12

-cycline (tetracycline HCL)
-prevent from multiplying
-animal bites, Lyme, chlamydia, STD, anthrax, long term acne, sub for PCN
-contraindications: pregnant, kids less than 8

Question 13

Tetracyclines AE

Answer 13

-GI: distress, esophagitis, N/V, flatulence
-yellow brown tooth discolor, hypoplasia tooth enemal
-hepatoxicity/ photosensitive/ superinfection
-dairy, calcium/iron, lax with mg, antacids reduce absorb
-empty stomach, separate 2hrs with diary etc.

Question 14

Sulfonamides

Answer 14

-prevents synthesis of folic acid
-use:UTI, chronic bronchitis, ulcerative colitis, burn infect, soft tissue
-contraindication: allergy, thiazide/diuretic (stop if rash), pregnant, infants less than 2 months (jaundice, increase bilirubin)

Question 15

Sulfonamides AE and interactions

Answer 15

-allergic, delayed cutaneous reactions (stevens johnson, necrolysis, photosensitive), blood/GI, sulfamylon (met acid, ABG)
-anti diabetic (hyperglycemia), decrease efficacy OCP, phenytoin (tox), warfarin (hemorrhage)
-IV needs to be over 60-90mins, never IM

Question 16

Urinary antiseptics

Answer 16

-bactericidal from high concentrate in renal and urine
-UTI, no systemic infections
-nitrofurantoin (furadantin, macrodantin)
-AE: hypersensitivity, GI upset, blood dyscrasias, neuropathy
-edu: urine (rust-brown), stain teeth, with food, avoid pregnant

Question 17

Miscellaneous antibiotics

Answer 17

-chloramphenicol: blood dyscrasias (aplastic anemia)

-clindamycin (cleocin): chronic bone infections,GU,intraabd, may cause pseudomembranous colitis

-linezolid (zyvox): VRE, skin; may cause hypotension, serotonin syndrome, reaction with tyramine food

-daptomycin (cubicin): skin by staph, strep,enterococcus, IV only, incompatible with dextrose

Question 18

Metronidazole (flagyl)

Answer 18

-use: anaerobic organisms, intraabd, gynecological infect, protozal infect

-interact: Antabuse with ETOH, inactivation of warfarin

SE/AE: GI upset, metallic taste, CNS sx (paresthesia, ataxia, seizure—STOP med)

Question 19

Vancomycin (vancocin)

Answer 19

-use: MRSA and gram + infect
-ototoxicity and nephrotoxicity
-additive neuromuscular blocking effects
-infuse over 60 mins or longer (rapid may cause hypotension)

Question 20

Vancomycin flushing syndrome

Answer 20

-red man syndrome

-massive histamine release

-erythema; flush; pruritis of head, neck, face, upper trunk; tachycardia, hypotension

-HOLD and notify PCP

-give antihistamine

Question 21

Nursing implications

Answer 21

-culture before antibiotic
-take exactly as prescribed
-s/s of superinfection (diarrhea with abd cramps and fever, perineal itching, cough, lethargy, unusual discharge)
-common AE N/V/D

Question 22

Macrolide/ketolide

Answer 22

-thromycin
-Macrolide: resp tract infect, PCN sub, GU infect, bac sinusitis, H. Pylori
-Ketolide: community acquired pneumonia
-con: hypersensitivity, liver dx, gravis
-AE: GI, hepatox, otototox, superinfection, prolong QT**
-slow infusion