Anti-Infectives Flashcards
What are ways to prevent anti-infective resistance?
— appropriate prescribing
— adequate dosing; maintain therapeutic level
— patient education: take as prescribed, complete entire prescription
What is the goal for use of antibiotics?
Cause bacterial cell death without causing damage to host cells
What is the cause of superinfections/secondary infections?
What are examples and CM?
— host flora suppressed by antibiotics
Examples: C. Diff, oral or vaginal yeast infections
CM:
— diarrhea
— cramping
— dysuria
— abnormal vag discharge
— rash
What will you educate your patient taking contraceptives that was given a new prescription for antibiotics?
— antibiotics make contraceptives less effective
— use additional protection for 7 days
Your patient takes warfarin, what is something to consider about this patient when taking antibiotics?
Antibiotics may increase anticoagulant effect of warfarin; can increase bleeding time
*monitor PT/INR
What are things to consider when administering oral antibiotics?
— take on empty stomach with full glass of water 1 hour before meals or 2-3 hours after
— do not take with fruit juice, soft drinks, or milk
What do you want to consider when giving IV antibiotics?
— observe site for phlebitis
— check rate of infusion
— check compatibility with other meds/fluids
— some antibiotics are central line proffered (vanco)
What are potential toxicities when giving antibiotics?
— AKI: decreased urine output, protein in urine, elevated creatinine and BUN
Prevention: adequate hydrations
— Neurotoxicity: headache, dizziness, confusion, seizures, loss of hearing, vision damage
— Liver toxicity: hepatitis, jaundice, elevated LFTs
What are common AE with antibiotics?
GI:
— nausea/vomiting
— diarrhea
SKIN:
— rash
— hives
*hypersensitivity reactions: may be immediate or delayed allergic reaction
— anaphylaxis can occur
— cross-sensitivity
— superinfections/secondary infections
What is gentamicin?
What are the AE, black box warning and nursing indication?
Class: Aminoglycosides
AE:
8th CN: tinnitus/hearing loss; systemic route higher risk for toxicity
BLACK BOX WARNING: nephrotoxicity, neurotoxicity; high alert=high potency
Nursing indications: draw peak (drawn 1-2 hr post medication infusion)
What is Ertapenem?
Class: carbapenems
— used for sepsis
— systemic route higher risk for toxicity
What is ciprofloxacin?
What are the AE?
What do you need to educate your client about?
Class: fluroquinolone
AE:
— photosensitivity (sunlight)
— tendon rupture possible with corticosteroids
— Dysrhythmia with IV route; need tele (prolonged QT interval)
Nursing indications:
— telemetry
— educate about use of sunscreen; high risk for sunburns
ADMINISTRATION CONSIDERATIONS:
— may give with food
— admin 4 hours before antiacids and ferrous sulfate
— NO DAIRY (decreased absorption)
What is erythromycin?
Class: macrolides
— used for eye infections
AE: IV route higher risk for toxicities
*do not give with fruit juices
What is amoxicillin?
Class: penicillins
*safest category for pregnancy (category B)
— decreases effectiveness of oral contraceptives
— increases anticoagulant effect of warfarin
General AE
What is cefazolin?
Class: cephalosporins (1st gen)
General AE; systemic routes higher risk for toxicity
Contraindication: allergy to penicillin; pregnancy category B
What is sulfamethoxazole?
What are the AE and contraindications?
Class: sulfonamides
AE:
— GI effects
— photosensitivity; teach about use sunscreen and avoid sunlight
Contraindications: SULFA ALLERGY; pregnancy/breast feeding
*may give with food to alleviate GI effects
What is doxycycline?
What are the AE and contraindications?
Class: tetracycline
AE: teeth discoloration, SEVERE PHOTOSENSITIVITY
Contraindications:
—pregnancy (slow fetal skeletal growth)
—children under 8y tooth enamel hypoplasia (development)
ADMIN CONSIDERATIONS:
— NO DAIRY (decreases absorption)
— administer with full glass of water
What is vancomycin?
What is something interesting regarding treatment using vanco?
AE and nursing indications:
Class: glycopeptide
IV vanco: can cause C. DIFF
Oral vanco: treats C. Diff
AE:
— superinfection
— nephrotoxicity
— ototoxicity (hearing loss)
— RED MAN SYNDROME (allergic reaction): hypotension, fever, chills, paresthesia, erythema on NECK AND BACK
Nursing indications:
— administer over 1 hour to prevent red man’s syndrome
— central line proffered
— TROUGH LEVELS (drawn 1 hr before start of med)
— see liver enzymes, renal function
What is metronidazole?
Class: misc. antibiotic/antiprotozoal
AE:
— CNS effects
— metallic taste
— SEVERE N/V WITH ALCOHOL INTAKE
Contraindication:
— renal/liver dysfunction
— pregnancy/lactation
What are AE with TB treatment medications?
How long is the treatment for TB?
Antibiotics/antimycobacterial agents:
— GI effects: nausea/vomiting, diarrhea
— orange tint to body fluids
— neuropathy
— bone marrow suppression
— LIVER TOXICITY
Nursing indication:
— monitor AE
— labs LFTs
— educate: take as directed, do not stop med
— TREATMENT 6 MO. TO 2Y
What is oseltamivir?
What do you use this to treat?
Antiviral: neuroaminidase inhibitor
*treatment for prophylaxis to decrease flu symptoms
Contradindications: pregnancy/breast feeding
AE: N/V/D
Nursing indications:
— tax should be initiated within 48hr of symptoms
— do NOT administer 48hr before vaccine or 2 weeks after
— may take with food to decrease GI intolerance
What is acyclovir?
Antivirals: prime nucleoside analog
*used to treat herpes, varicella zoster (shingles)
AE: oral; fatigue, headache, n/v/d
IV: nephrotoxicity/neurotoxicity
Nursing indications:
— oral: administer with food
— topical: wear gloves
— IV: infuse over 1 hr to decrease renal damage
— ensure hydration
*NOT A CURE
What is the treatment for HIV/AIDS?
Antiretroviral drugs:
Combination of at least 3 different antiviral drugs
*HIV mutates over time, leading to drug resistance
AE:
— GI effects
— CNS effects
— flu-like syndrome
— risk for toxicity
What is nystatin?
Topical anti fungal agent:
— used to treat candida infections: vagina, skin, mouth
AE:
— topical: contact dermatitis
— oral: n/v/d
Nursing indications:
— oral: educate pt to swish for 2 min and swallow; swab may be used with children
— topical: use gloves
What is fluconazole?
Systemic anti fungal agents: azoles
*used for superficial fungal infections
AE:
— N/V/D
— longer duration: liver toxicity
Nursing indications:
— LFTs
— liver toxicity 3-6 mo.
DRUG-DRUG INTERACTION:
WARFARIN=BLEEDING
ANTI-DIABETICS=HYPOGLYCEMIA
