Anti-Infective Drugs Flashcards
Anti-infective agent: Any drug/agent effective against some type of pathogens; umbrella term
All have Sim Goal: Reduce population/amount of invading organisms to allow immune response to eliminate rest - why infections problematic in immunocompromised: anti-infectives aid to own immune sys so if not properly working drugs to treat organisms not as effective so is prob for these pats and want them to avoid infections in first place because drugs only help so much; reduce amount invading organism
Anti-infectives overview
Immune compromised problematic
All have Sim Goal: Reduce population/amount of invading organisms to allow immune response to eliminate rest - why infections problematic in immunocompromised: anti-infectives aid to own immune sys so if not properly working drugs to treat organisms not as effective so is prob for these pats and want them to avoid infections in first place because drugs only help so much; reduce amount invading organism
Drugs cause toxicity due to client status
Immune system cannot fight remaining pathogens
Immune compromised problematic
Occurs with any anti-infectives
Develops through mutation from organ - resistance occurs; when things mutate treatments not helpful or fight as well as once did - problematic because might run out of treatment options; prevention of resistance imp
Accelerated by/occur by sev diff things:
Prevention
Lot resistance already occurring - prob if new ones not created to fight infections
Anti-infective resistance
Inappropriate prescribing (e.g., antibiotic for virus) - taking med for something not have so allows for more resistance of organism
Ineffective dosing - not prescribe long-enough duration to adequately kill bacteria; if happens that gives bacterium more opportunity to mutate and change (sees antibiotic but not killed all way and learns how to evade it)
Widespread use - using lot anti-infectives in lot diff pops; overusing it in diff pops and more used more likely evade treatment options and get around them
Accelerated by/occur by sev diff things:
Appropriate prescribing - imp for HCP be educated on best anti-infective for organism grown
Adequate dosing (maintain therapeutic level) - makes sure organism effectively erradicated
Patient education: vital educate take prescription as prescribed; complete entire prescription; vital that educate patients on this; take for entire duration regardless if feel better/symps away; if end too early allows come back and more risk for resistance and mutation; do not share meds with others
Prevention
Goal: Cause bacterial cell death without causing damage to host cells - hard; kill bacteria without causing probs to other host cells; will have some AE as a result
Treat bacterial infections
Mechanism of Action (MOA)
Big concept: All antibiotics cause cell death of bacteria if effective
Antibiotics
Interfere with biosynthesis of pathogen cell wall (penicillin)
Prevent pathogen growth and reproduction division (sulfonamides)
Interfere with steps involved in protein synthesis (aminoglycosides)
Interfere with DNA synthesis in cell (fluoroquinolones)
Alter permeability of cell membrane - leak essentials (antifungal, antiprotozoal, and some antibiotics)
Mechanism of Action (MOA) - antibiotics
Effective for a wide variety of bacteria
Treat wide variety of bacteria
Based on best guess; used first in treatment - cover lot diff types organisms; not know what causing certain thing give these and feel confident start kill off some organism
Used in sepsis protocol - really sick because infections in bloodstream and need take action quickly; get cultures and once come back change course treatment based on organisms growing - where narrow-spectrum antibiotics come into play
Broad-spectrum antibiotics
Selective group of bacteria
Based on results of C&S - see which antibiotics bacteria sensitive to
Better in that help decrease resistance - not using something that treats number things
Narrow-spectrum antibiotics
Two or more drugs intitially and as infections improve d/c antibitoics over time depending on pat
May need multiple antibiotics
Combination therapy
Identify pathogen
Drug (antibiotic) most effective against pathogen involved - C&S (diff ways to get - to determine which drug most effective)
Drug that will cause least AE/complications for client
Consider patient allergy profile - past history; allergies? Comorbidities - sig renal disease - need ones less toxic
HCP considers factors:
GI effects
Skin effects
Hypersensitivity reactions - allergic rxns
Superinfections/secondary infections
Antibiotics: Common Adverse Effects
Nausea, vomiting, diarrhea (n/v/d) - pretty common on some degree for lot pats; monitor pat for these and decide severity
GI effects (Antibiotics: Common Adverse Effects)
Developing a Rash, hives (hypersensitivity rxn); monitor for both of these
Skin effects (Antibiotics: Common Adverse Effects)
Most commonly occur with very first dose; sometimes also during second dose; first and second dose most crucial for monitoring for severe rxn - but can happen at any time; taken many times risk for rxn much lower; first time watch closer
May be immediate, with next exposure, or delayed allergic (48+ hours out)
Severe cases, anaphylaxis can occur
Cross-sensitivity between classifications of antibiotics (e.g., penicillins & cephalosporins) possible - 2 diff classes and if allergic to 1 likely allergic to other higher; 10% not okay but imp know - imp to monitor closely esp if never taken
Determine what client experienced - true allergy or expected adverse effect - assess rxn; imp have correct: want make sure have availability as many antibiotics classifications as possible to treat appropriately
Hypersensitivity reactions - allergic rxns (Antibiotics: Common Adverse Effects)
EX: C. diff, yeast infections
Superinfections/secondary infections (Antibiotics: Common Adverse Effects)
Cause:
Clinical manifestations vary:
Examples:
superinfections/secondary infections
Occur because Host flora suppressed by antibiotics; Pathogenic microorganisms multiply
More likely occur with certain antibiotics than others
Opportunistic—suppressed immune system - immunocompressed more higher risk
Cause: (superinfections/secondary infections)
Diarrhea/cramping, painful urination, abnormal vaginal discharge, rash…
Clinical manifestations vary:(superinfections/secondary infections)
Clostridium difficile (C. diff) overgrowth
Candida albicans (oral or vaginal yeast)
C.diff and yeast infections more common/imp monitor for
Examples: (superinfections/secondary infections)
Toxicities more likely occur with IV because more potent; if on multiple IV antibiotics risk increases; order toxicities most to least prevalent
Acute kidney injury
Neurotoxicity
Liver toxicity
Potential toxicities with antibiotics (order of probability)
Most likely suffer from renal toxicity; when on IV antibiotics look at creatinine and BUN on reg basis to make sure kidney func not declining; not showing kidney injury; monitor urine output closely
CM: Decrease urine output, protein in urine, elevated creatinine and BUN; decreased GFR
Prevention renal toxicity: adequate hydration; do that: diluting antibiotic; not effecting the effectiveness of antibiotic - helps dilute it out; not as toxic on kidneys or hard renal tubules - may give IV fluids; outpat - stay adequately hydrated
Acute kidney injury
More likely occur for IV antibiotics
Nothing to prevent this
CM: headache, dizziness, confusion, seizures, loss of hearing (ototoxicity), vision damage
Neurotoxicity
CM: Hepatitis (jaundice, elevated liver function tests (LFTs))
Least likely to occur on antibiotics
Liver toxicity
Monitor them closely for allergic reaction (most likely give antibiotic first time taken it - more likely allergic rxns occur with them) and superinfections
Ensure adequate hydration and nutritional status
Children - Antibiotics across the lifespan
Instructions to take all medication as directed or prescribed/do not save or share meds
Females on birth control pill-use additional protection against pregnancy - antibiotics make birth control less effective; if have a female of child-bearing age imp to assess and ask if taking oral contraceptives to prevent pregnancy and know less effective when on antibiotics and use alternate protection and use for up to 7 days after
Adults - Antibiotics across the lifespan
Most antibiotics contraindicated; risk vs. benefit
Gen Most category C
Penicillin: category B
Should be avoided if possible; HCP makes decision on antibiotics appropriate, trimester, etc
Pregnancy - Antibiotics across the lifespan
Higher risk for toxicity (reduced liver, kidney function) - risk for renal toxicity because may have some decline kidney func and more risk for toxicity of med because kidneys not working up to speed
Older adult - Antibiotics across the lifespan
Prior to administration:
When administering antibiotics things to keep in mind depending on route (2 most common listed and most implications to know):
Throughout administration of antibiotics:
Patient Education:
General Nursing Responsibilities
Complete assessment and health history
Obtain cultures as indicated prior to admin - best get samples before admin antibiotics if can
assess/Note s/s of current infection:
Antibiotics may increase anticoagulant effect of warfarin; monitor PT/INR and draw it additionally; increases bleeding time
Prior to administration:
Diseases - know why giving antibiotics (kind infection have), pregnancy, reviewing allergies, drugs (all med history so aware d-d interaction), OTC’s, alcohol, major comorbidities - risk for giving antibiotics - CKD
Complete assessment and health history
Should not delay care; nurse may obtain culture before get cultures-then hold for order
Obtain cultures as indicated prior to admin - best get samples before admin antibiotics if can
Fever, fatigue, elevated WBC count, redness, swelling, discomfort, draw with sharpie… - ways to easily track progress; note any signs of infection
assess/Note s/s of current infection:
One most common routes
Take on empty stomach with full glass of water 1 hour before meals or 2-3 hours after meals
Do not take with/avoid fruit juice, soft drinks, or milk when administering antibiotics
Oral: - When administering antibiotics things to keep in mind depending on route (2 most common listed and most implications to know):
One most common routes
Observe IV site closely esp if admin through peripheral IV
Some can be vasocostic and cause phlebitis - monitor closely
Observe for phlebitis
Check rate of infusion or intravenous push (IVP) - get med should directions from pharmacy how long to infuse over and take note; diff for every antibiotics; same for push rates
Check compatibility with other meds/IV fluids - in same IV must be compatible so can run together without issues so and if not will precipitate and cause probs in line/pat - sometimes add line to present one and antibiotics may be intermittent - attentive to line present and what line putting it in
Some antibiotics central line preferred - Vancomycin - if have central line use it when giving antibiotics; can give through peripheral line - make sure infusing appropriate rate and monitoring site very closely throughout admin to make sure nothing happening at site; but once can go to central line
IV: - When administering antibiotics things to keep in mind depending on route (2 most common listed and most implications to know):
Monitor and report
Peak or trough if appropriate - some have these ordered; watch orders
Ensure adequate hydration to prevent accumulation of drug and reduce risk of AKI
Throughout administration of antibiotics:
Therapeutic effects - infection better, VS improved
Monitor appropriate Lab values
Adverse effects
Throughout administration of antibiotics:
CBC (WBC mainly), kidney function (toxicities), LFTs (toxicities), looking at if WBC down, line drew on leg infection drawing away from line
Monitor appropriate Lab values
Take as directed (entire prescription)
Females taking birth control pills (use alternative protection)
Drink 3 L water per day
Report AE that are expected to HCP - what should do if having AE
Patient Education:
The nurse is educating an older adult female regarding antibiotic therapy. Which information is most important to include in the client’s education?
A.Use alternate protection against pregnancy if taking birth control pills.
B.Report nausea to your healthcare provider.
C.Take with food if experiencing gastrointestinal upset.
D.Drink at least 3 L of water daily.
Answer: D
Rationale: Older adult is at increased risk for renal toxicity. An older adult female is at low to no risk for pregnancy. Nausea and GI upset should be included in the education but are not the priority. older adult: means not of child-bearing age, gone through menopause
The nurse is caring for a client taking a penicillin antibiotic. Several days into the course of therapy the client calls the clinic complaining of a diffuse red rash but otherwise feeling well. What is the client most likely experiencing?
A.Candida yeast infection
B.Anaphylaxis
C.Delayed allergic reaction
D.Steven’s Johnson Syndrome
Answer: C
Rationale: The client is experiencing a delayed allergic reaction which usually occurs several hours to several days into therapy. Candida would be a localized rash with itching. Swelling, itching, and difficulty breathing would accompany anaphylaxis. SJS is a rare complication with a blistering rash and other life-threatening systemic manifestations.
Diffuse - all over
Otherwise feeling well; steer away from Steven’s Johnson - systemic and very serious/critically ill pat
Anaphylaxis - more symptomatic; hypotensive, not being able breath
Yeast - concentrate fungal; underneath breast/in mouth
Aminoglycosides
Carbapenems
Cephalosporins
Fluoroquinolones
Macrolides
Penicillins
Sulfonamides
Tetracyclines
Miscellaneous antibiotics
Classifications: antibiotics
toxic to 8th CN (deals with hearing - monitor for tinnitus (ringing of ears), hearing loss); systemic routes higher risk toxicities - IV - more likely have toxicity
AE: - Aminoglycosides: Prototype: Gentamicin
nephrotoxicity, neurotoxicity - potent antibiotic
Black Box (high alerts): - Aminoglycosides: Prototype: Gentamicin
draw peak; see general slides
Nursing: - Aminoglycosides: Prototype: Gentamicin
