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Pharm > Antibacterials > Flashcards

Antibacterials Flashcards

1
Q

What is the goal & outcome of antibacterial therapy?

A

Goal of therapy: kill bacteria or prevent their reproduction without harming the patient

Outcome: Disappearance of s/sx of infection

E.g. WBC between 5,000 and 10,000; no redness or drainage of wound, normal body temperature

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2
Q

General adverse reactions to antibacterials

A
  • Allergic reactions (hypersensitivity or anaphylaxis)
  • Superinfection
  • Organ toxicity
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3
Q

Secondary infections that occur when too many host flora are killed by an antibiotic.

Host flora prevent growth of pathogenic organisms

Pathogenic microorganisms have chance to multiply

S/sx include diarrhea, bladder pain, painful urination, or abnormal vaginal discharge

A

Superinfections

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4
Q

Infections that take advantage of suppressed immune system

A

opportunistic infections

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5
Q

C. Diff is a bacteria that can cause severe diarrhea and colitis (which is inflammation of the colon). How does it spread?

A

C. diff spreads when people touch food, surfaces, or objects that are contaminated with feces (poop) from a person who has C. diff.

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6
Q

Do antibiotics only kill bad bacteria?

A

No. Antibiotics kill both good and bad bacteria.

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7
Q

Antibiotics effective against many gram + and gram – organisms organisms

A

Broad spectrum antibiotics

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8
Q

Antibiotics that primarily act against a single organism or a limited group of organisms

A

Narrow spectrum antibiotics

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9
Q

Why should we do a C&S before starting antibiotics

A

Aculture is atestto find microorganism responsible for causing an infection.

Asensitivity testchecks to see what kind of medicine, such as an antibiotic, will work best to treat the illness or infection.

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10
Q

How long does it take for bacteria be seen in culture?

A

Most bacteria can be seen in culture in 2-3 days (could take 10 days or longer)

Broad-spectrum antibiotics may be started before lab culture completed

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11
Q

Major Classes of Antibiotics by Pharmacologic Classification

A

Penicillins (ends with cillin)
Cephalosporins (starts with cef or ceph)
Macrolides (ends with mycin or micin)
Glycopeptides
Tetracyclines (ends with cycline)
Aminoglycosides (ends with mycin or micin)
Fluoroquinolones (ends with floxacin)
Sulfonamides (starts with sulf)

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12
Q

Bactericidal
Most widely effective
Least toxic
Major side effect: allergy

A

Penicillin

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13
Q

Side effects & adverse effects of penicillin

A

Side effects: NVD, pain at injection site

Adverse effects: bacterial resistance, allergic reaction, anaphylaxis, Clostridium difficile-associated diarrhea

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14
Q

What drugs are given to protect the beta-lactam antibiotic (penicillin) from being destroyed?

Don’t have antimicrobial action

A

Beta-lactamase inhibitors

Ex: Amoxicillin-clavulanic acid (Augmentin), Ampicillin-sulbactam (Unasyn), Piperacillin-tazobactam (Zosyn), Ticarcillin-clavulanic acid (Timentin)

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15
Q

Nursing interventions for penicillin

A

-Obtain C & S specimen
-Monitor for evidence of superinfection, especially in patients taking high doses of an antibiotic for a prolonged time.
-Examine the patient for an allergic reaction, especially after the 1st and 2nd doses.
-Instruct patient to take complete course of treatment.

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16
Q

3rd generation cephalosporin

A

Ceftiaxone (Rocephin)

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17
Q

Side effects & adverse effects of ceftiaxone (Rocephin)

A

Side effects: GI distress (nausea, vomiting, diarrhea), Alteration in blood clotting (increased bleeding)

Adverse effects: Nephrotoxicity, Stevens-Johnson syndrome, Anaphylaxis, Thrombocytopenia

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18
Q

Ceftiaxone (Rocephin) drug interactions

A

Alcohol
May cause disulfiram-like reaction
Flushing, dizziness, headache, nausea, vomiting, and muscular cramps

Disulfiram (also called Antabuse) is given to people who chronically drink alcohol- it causes an acute reaction when the person drinks alcohol after taking this drug

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19
Q

Nursing interventions for Ceftiaxone (Rocephin)

A

-C & S prior to starting antibiotic
-Tell patient to report signs of superinfection.
-Instruct patient to take complete course of treatment.
-Observe for hypersensitivity reactions.
-Advise patient to take medication with food if gastric irritation occurs.

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20
Q

Penicillin substitute

Used if pt has a hypersensitivity to penicillin

A

Macrolides

Ex: Azithromycin

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21
Q

Side effects of Macrolides

A

GI distress including nausea, vomiting, diarrhea, cramping
Photosensitivity
Headache, fatigue, dizziness
Oral candidiasis

22
Q

Adverse effects of Macrolides

A

Anaphylaxis
Superinfection
Hepatotoxicity (use with caution in patients with hepatic dysfunction)
Stevens-Johnson syndrome
Blood dyscrasias

23
Q

Nursing interventions for Macrolides

A

Obtain a sample for C&S testing before starting antibiotic.
Monitor the patient for liver damage.**
Administer antacids either 2 hours before or 2 hours after taking**
Encourage patient to report side effects/adverse effects.
Tell patient to report onset of loose stools/diarrhea (c-diff)**

24
Q

Drugs used to treat MRSA, pseudomembranous colitis caused by clostridium difficile

Dosing may be based on peak & trough levels

A

Glycopeptides

Ex: Vancomycin

25
Q

Side effects of Glycopeptides

A

GI symptoms (nausea, vomiting)
Dizziness
Superinfection
Disulfiram-like reaction to alcohol

26
Q

Adverse reactions of Glycopeptides

Ex: Vancomycin

A

Ototoxicity**
Nephrotoxicity**
Anaphylaxis
Blood dyscrasias
Stevens-Johnson syndrome
Clostridium difficile-associated diarrhea

27
Q

S/sx of adverse reaction of Glycopeptides

Ex: Vancomycin

A

Occurs when IV too rapid
Severe hypotension
Red blotching of face, neck, chest, extremities
Toxic reaction not allergic reaction

28
Q

Nursing interventions for Vanco

A

Check C&S before therapy
Monitor vancomycin levels**
Administer over 1 to 2 hours IV**
Monitor BP**
Monitor renal function tests (BUN and creatinine) and hearing**
Monitor patient for superinfection

29
Q

Tetracyclines prototype

A

Doxycycline

30
Q

Side effects of Tetracyclines

A

Nausea and vomiting
Diarrhea
Photosensitivity (severe burns)
Discoloration or hypopolasia of teeth and temporary stunting of growth
Do not give to children younger than 8 years.
Stomatitis, glossitis

31
Q

Adverse effects of Tetracyclines

A

Anaphylaxis
Clostridium difficile-associated diarrhea
Ototoxicity, hepatotoxicity, nephrotoxicity
CNS toxicity
Pancytopenia, Stevens-Johnson syndrome

32
Q

Drug/food interactions for Tetracyclines

A

Milk products (decreased absorption)
Antacids
Oral contraceptives
Penicillins
Aminoglycosides

33
Q

Nursing interventions for Tetracyclines

A

Check C&S before drug
Monitor kidney and liver function.**
Take on an empty stomach and full glass of water **
Advise patient to use sunscreen (photosensitivity)**
Teach patient to report superinfection.
Warn patient to avoid milk, iron, antacids (interfere with absorption).**

Recommend that the patient use a non-hormonal birth control method in addition to OCP’s (to reduce risk of pregnancy and is also Class D medication)**

34
Q

Aminoglycosides prototype

A

Gentamycin

35
Q

Side effects of Aminoglycosides

A

Photosensitivity
Superinfection
Stomatitis
Nausea, vomiting
Fever
Lethargy

36
Q

Adverse effects of Aminoglycosides

A

Anaphylaxis
Seizures
Ototoxicity
Nephrotoxicity
Clostridium difficile–associated diarrhea
Stevens-Johnson syndrome

37
Q

Nursing interventions for Aminoglycosides

A

-Check C&S.
-Check for hearing loss and renal function.**
-Check that therapeutic drug monitoring has been ordered for Peak & Trough drug levels.**
-Monitor for s/sx of superinfection

38
Q

Sulfonamide prototype

A

Trimethoprim-Sulfamethoxazole (Bactrim, Septral)

39
Q

Why are both drugs, Trimethoprim- Sulfamethoxazole, used together in one compound?

A

cause bacterial resistance to develop much more slowly.

40
Q

Side effects/adverse effects of Trimethoprim-Sulfamethoxazole

A

GI distress, stomatitis, photosensitivity
Crystalluria, renal failure
Blood dyscrasias, Stevens-Johnson syndrome

41
Q

Nursing interventions for Trimethoprim-Sulfamethoxazole

A

Increase fluid intake to at least 2000 mL/day.**
Monitor CBC and renal function.**
Monitor for rash, superinfection.
Avoid during third trimester.**
Avoid antacids**
Monitor for sore throat, bruising, bleeding**
Teach patient to avoid direct sunlight**

42
Q

Fluroquinolones prototype

A

Ciprofloxacin (Cipro)

43
Q

Side effects of Fluroquinolones

A

Rash, nausea, headache, abdominal pain, vomiting, dizziness, changes in taste, sleep disturbances, photosensitivity

44
Q

Adverse effects of Fluroquinolones

A

Serious heart dysrhythmias (esp. when taken with other drugs), neurotoxicity, Stevens-Johnson syndrome, changes in blood glucose level, tendon rupture, peripheral neuropathy

45
Q

Drug interactions for Fluroquinolones

A

Antacids decrease absorption rate.
May increase effect of oral hypoglycemics

46
Q

Nursing interventions for Fluroquinolones

A

Check C&S.
Monitor heart rate and rhythm**
Infuse IV over 60 to 90 minutes.**
Increase fluid intake to more than 2000 mL/d. **
Tell patient to avoid caffeine.**
Check for superinfection
Teach patient to stop drug and notify prescriber of any tendon or joint pain/swelling**
Monitor blood glucose**

47
Q

Combo antibiotics should be reserved for

A

specific uncontrolled infections

48
Q

When two antibiotics are combined, the result may be additive, potentiative, or antagonistic

A

Additive- effect is equal to the sum of the effects of two antibiotics

Potentiative- effect occurs when one antibiotic potentiates the effect of the second, increasing its effectiveness

Antagonistic- when two drugs are used together and the desired effect is reduced

49
Q

When a bactericidal (like penicillin) and a bacteriostatic (tetracycline) are used together, the effect is greatly

A

reduced

50
Q

Antibacterial resistance is caused by

A

overused, overprescribed, improperly taken antibacterial drugs

51
Q

General take-home points

A

Finish medication to prevent superinfection

Decreases oral contraception effectiveness in amoxycillin, doxycycline

No alcohol- antibiotics can harm the liver

Take on an empty stomach and full glass of water with azithromycin (macrolides), doxycycline (tetracycline), levofloxacin (fluoroquinolones)

No sun with levofloxacin (fluoroquinolones), doxycycline (tetracyclines), sulfa drugs (Bactrim)

Vancomycin, gentamycin, neomycin- very toxic to kidneys and ears

Take amoxicillin with food to decrease GI symptoms and increase absorption

Vanco is incompatible with a lot of IV drugs, so be careful when infusion

Pharm (19 decks)

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