Antibiotic Drugs Flashcards
1
Q
It is also known as prokaryotes which are single-celled organisms that lack a true nucleus and nuclear membrane and has a cell wall that determines its shape.
A
Bacteria
2
Q
He devised a method to classify bacteria using the Gram-stain method
A
Hans Christian Gram
3
Q
Antibacterial Drugs
A
- Substances that inhibit bacterial growth or kill bacteria and other microorganisms
- Drugs do not act alone in destroying bacteria. Together with natural body defenses, surgical procedures and dressing changes are needed to eliminate infecting bacteria
- These drugs are either obtained from natural sources or are manufactured
- Penetrates the bacterial cell wall and has an affinity for the bacteria’s binding sites
- The more time the drug remains bound, the longer the effect of the antibacterial action
4
Q
Alexander Fleming
A
He discovered the mold that produced Penicillin which was the first antibiotic to be used and marketed
5
Q
Antiseptic vs. Disinfectants
A
Antiseptic is used in living tissue, has a lower potency, and primarily inhibits growth (bacteriostatic). On the other hand, disinfectants is used for nonliving objects, has a higher potency, and kills (bactericidal)
6
Q
Five Mechanisms of Antibacterial Action
A
- Inhibition of bacterial cell-wall synthesis
- Alteration of membrane permeability
- Inhibition of protein synthesis
- Inhibition of the synthesis of bacterial RNA and DNA
- Interference with metabolism within the cell
7
Q
MEC or Minimum Effective Concentration
A
minimum amount of antibacterial drug to halt the growth of microorganisms
8
Q
Resistance to Antibacterial Drugs
A
a. When bacteria are sensitive to the drug = the pathogen can be inhibited or destroyed
b. When bacteria are resistant to the drug = the pathogen will continue to grow despite the administration
9
Q
Two Types of Resistance
A
- inherent –occurs without previous exposure to the drug;
- acquired –caused by prior exposure to the antibacterial
10
Q
Type and Considerations of General Adverse Reactions to Antibacterial Drugs
A
- Allergy or Hypersensitivity
- may be mild or severe
- mild reactions include rash, pruritus, and hives and are treated with an antihistamines
- severe response includes anaphylactic shock, which results in vascular collapse, laryngeal edema, bronchospasm, and cardiac arrest and generally occurs within 20 minutes.
- anaphylaxis required treatment with epinephrine, bronchodilators, and antihistamines.
11
Q
Type and Considerations of General Adverse Reactions to Antibacterial Drugs
A
- Superinfection
- a secondary infection that occurs when the normal microbial flora of the body is disturbed during antibiotic therapy.
- can occur in the mouth, respiratory tract, intestine, genitourinary tract, and skin.
- maybe caused by fungal infections (proteus, Pseudomonas, staphylococcus) may be the offending microorganisms
- rarely developed when the drug is administered for less than a week, and they occur more commonly with broad-spectrum antibiotics.
12
Q
Nystatin
A
Frequently used for fungal infection of the mouth.
13
Q
Type and Considerations of General Adverse Reactions to Antibacterial Drugs
A
- Organ Toxicity
- liver and kidneys are involved in drug metabolism and excretion, and antibacterial may result in damage to these organs. For example, aminoglycosides can be nephrotoxic and ototoxic
14
Q
Additive Effect
A
An antibiotic combination that is equal to the sum of the effects of two antibiotics.
15
Q
Potentiative Effect
A
An antibiotic combination that occurs when one antibiotic increases the effectiveness of the 2nd drug
16
Q
Antagonistic Effect
A
An antibiotic combination that hen two drugs are used together, the desired effect may be greatly reduced.
17
Q
Narrow Spectrum
A
primarily effective against one type of organism (selective)
18
Q
Broad Spectrum
A
effective against gram-positive and gram-negative organisms
19
Q
Empiric Therapy
A
when a drug selected is known to be the best drug that can kill the MO
20
Q
Definitive Therapy
A
once the MO is identified in the lab, the antibiotic therapy is tailored by using the most narrow-spectrum, least toxic drug based on culture and sensitivity results
21
Q
Subtherapeutic
A
when signs and symptoms do not improve
22
Q
Superinfections
A
occurs when the antibiotics reduce or completely eliminate the normal bacterial flora
23
Q
Why does laboratory testing is being performed on body fluids such as blood, urine, sputum, and wound drainage?
A
to determine the M’s causing infection
24
Q
Gram Stain
A
aspirate of the body fluid is examined under the microscope
25
Culture
aspirated is applied to a medium where they are grown for several days
26
Sensitivity
used for organisms where resistance is common, to test for sensitivity of the organisms to various antimicrobials
27
Host Factor of Antibacterial Drugs
immune system
site of infection
age
pregnancy
28
Prophylactic Use of Antibacterial Drugs
Indications:
1. Prevention of infection for clients with GIT, Cardio, Orthopedic or Gynecologic surgeries
2. Prevention of STI’s following sexual exposure
Limit prophylactic use to patients with
1. Prosthetic heart valves
2. Recurring urinary tract infections
29
Beta-Lactam Antibiotics
- drugs that contain beta-lactam rings on their structures include: penicillin, cephalosporins, carbapenems, and monobactams that inhibit the synthesis of bacterial peptidoglycan cell wall
- needs an additional drug called Beta-lactamase inhibitor to make the drug more powerful against the MOs
30
Beta-Lactamase
An enzyme produced by some bacterial strains that provides resistance by destroying the beta-lactam ring in the drugs.
31
Penicillins
- DOC for gram-positive cocci such as Streptococcus pneumoniae, viridans and pyogenes
- DOC for meningitis caused by gram-negative cocci, Neisseria meningitides
- DOC for syphilis caused by Spirochete treponema pallidum
- Extended Spectrum is effective against Pseudomonas, Enterobacter, proteus, bacteroides, klebsiella
- Prophylaxis against bacterial endocarditis prior to dental and other procedures
32
Adverse Effects and Nursing Interventions/Client Education (Penicillin)
Allergies/Anaphylaxis
- interview clients for prior allergy
- advise clients to wear an allergy identification bracelet
- observe clients for 30 minutes following administration of parenteral penicillin
Renal Impairment
- monitor kidney function
- monitor input and output
Hyperkalemia/dysrhythmias (high doses of penicillin G potassium) and Hypernatremia (IV ticarcillin)
- monitor the cardiac status and electrolyte levels
33
Contraindications/Precautions (Penicillins)
- contraindicated for clients who have a severe history of allergies
- use cautiously in clients who have or are at risk for kidney dysfunction
- Penicillin Skin Test done prior to administration
- Pregnancy category B
34
A procedure recommended for some patients with a history of allergic reaction such as itching, hives, rash, swelling, or shortness of breath.
Penicillin Skin Testing
35
Mast cell activation
results in positive skin test and are said to be sensitized which may be give them a high risk for immediate allergic reaction
36
Negative Reaction
No reaction at the penicillin testing sites. The client will be given amoxicillin by mouth and observed to confirm you are not allergic to penicillin drugs
37
Positive Reaction
Itching, redness, and hive at any penicillin testing site confirm you are allergic to penicillin. These reactions usually resolve in under 1 hour.
38
Penicillin Drug
Most as excreted via the kidneys thus assessment of BUN and Creatinine for renal function is important
- Common adverse reaction includes: hypersensitivity and superinfection (occurrence of secondary infection when the flora of the body are disturbed); GI Distress (anorexia, N&V, diarrhea)
- W/O for interactions with potassium supplements and use of aminoglycosides
- W/O Clostridium difficile-associated diarrhea (superinfection)¡Teach patients to take the entire prescribed penicillin product to prevent drug resistance
39
Cepgalosporins
From a fungus discovered in seawater, its molecules are chemically altered and semi-synthetic medications are produced
40
Nursing Administration (Penicillin)
1. Instruct clients to complete the prescribed course of therapy, even though symptoms can resolve before the full course of antimicrobial treatment is completed
2. Advise clients to take oral cephalosporins with food
3. Instruct clients to store oral cephalosporin suspensions in a refrigerator
41
Carbapenems
- Have the broadest antibacterial actions of any antibiotics; Bactericidal and inhibit cell wall synthesis and are often reserved for complicated body cavity and connective tissue infections
- W/O for drug-induced seizure activity
42
ANTIBIOTICS AFFECTING PROTEIN SYNTHESIS: Tetracyclines
- Binds to 30s ribosomal unit of the MOs
- Binds to Ca, Mg, and Al metallic ions to form complexes that reduce the absorption of the drug when administered together with milk, antacids, and iron salts
- Not given to children below 8 years old, pregnant and lactating mothers d/t significant tooth discoloration of the child
- DOC for Rickettsia, Chlamydia, and Mycoplasma, spirochetes such as syphilis and Lyme
- CI: pregnancy category D, use cautiously for patients with liver and renal disease
- Should be taken on an empty stomach with a full glass of water
- Advise patients not to take tetracyclines before lying down due to increased risk of esophageal ulceration
43
ANTIBIOTICS AFFECTING PROTEIN SYNTHESIS: Macrolides
- Bacteriostatic but with high enough concentrations may be bactericidal via binding with 50s ribosomes of MOs
- Most common macrolides are: 1) Azithromycin
2) Clarithromycin
3) Erythromycin (not given IM usually)
- Administer oral preparation on an empty stomach (1hr before or 2 hrs after) with a full glass of water unless with GI distress
- azithromycin may be administered with food
- Monitor PT/INR of clients who take warfarin and liver function for patients taking the medication for more than 2 weeks
44
ANTIBIOTICS AFFECTING PROTEIN SYNTHESIS: Aminoglycosides
- Bactericidal and potent thus DOC for virulent infections through binding with 30S ribosome
- Have a post-antibiotic effect –continued bacterial growth suppression after antibiotic exposure
- Not given orally d/t poor absorption (except neomycin)
- Most common aminoglycosides are:
1) amikacin
2) gentamicin
3) tobramycin
- High nephrotoxicity and ototoxicity risks so maintained on TDM
- Use cautiously in clients with kidney impairment, premature and full-term neonates
- Pregnancy Category C-D-with several case reports of total irreversible bilateral congenital deafness
- Duration of therapy is as short as possible
- Concurrent use with loop diuretics and other antibiotics may increase the risk of ototoxicity, and may reduce vitamin K in the gut
45
It destroys bacteria by altering their DNA and does not affect human DNA. It is a very potent bactericidal broad-spectrum antibiotic and suitable for treating complicated UTIs, but can be given to patients with respiratory, skin, GIT and bone infections
Quinolones
46
Sulfonamides and Trimethoprim
Inhibits bacterial growth by preventing the synthesis of folic acid and is used as a treatment for UTIs caused by: E. Coli, Klebsiella, Enterobacter, and Neisseria. Examples of drugs include Sulfamethoxazole-Trimethoprim (SMZ-TMP). It has a contraindication of folic acid deficiency, with renal dysfunction, older than 65 years old taking ACEi and ARBs for risk of hyperkalemia and should take on an empty stomach with a full glass of water.
47
Antiseptics
Broad spectrum antiseptic through damaging MO’s DNA and indicated for acute UTI and prophylaxis of recurrent UTI. Example drugs include Nitrofurantoin, and nitrofurantoin macrocrystals, methenamine. Has a contraindication for patients with renal dysfunction which can cause increased toxicity. The client's urine may have brownish discoloration and may cause tooth staining.
48
Nursing Process For Antibiotics
Assessment for Admission
1. History of hypersensitivity to medications
2. Determine age, weight, V/S
3. Examine Labs such as BUN, Creatinine, AST and ALT, cardiac function, CBC, platelet and clotting
4. Monitor I&O (NV: 30mL/hror 600mL/day)
49
Nursing Process for Antibiotics
Nursing Diagnosis
1. Noncompliance with the treatment regimen related to lack of information and/or inability to pay for and obtain the necessary medication
2. Deficient knowledge related to lack of information about the disease process and the medication regimen
3. Risk for infection related to the patient’s possible development of a compromised immune status (due to the use of sulfonamides)
50
Nursing Process for Antibiotics
Nursing Planning
1. Patient remains compliant with the antibiotic therapy regimen for the full duration of treatment. 2. Patient demonstrates an increase in knowledge and information about the disease process and related drug therapy. 3. Patient maintains homeostasis and a healthy immune system and is free from risk for infection.
51
Nursing Process for Antibiotics
IMPLEMENTATION
1. Give oral medications within the recommended time frames and fluids as indicated
2. All medicated are to be taken as ordered and in full to maintain effective blood levels
3. Doses are not doubled up or omitted
4. Not given at the same time as antacids, calcium, iron, laxatives, and some anti-lipemic medications
5. Herbal products may be used only if there are no interactions
6. Continue checking for hypersensitivity until 72h
7. withhold medications immediately when signs of hypersensitivity are observed
52
TUBERCULOSIS
characterized by granulomas in the lungs from accumulation of inflammatory cells with a cheesy caseated consistency
53
Types of Tuberculosis
M. Tuberculosis –most common, present as a pulmonary disease
M. leprae –causing leprosy, observed symptoms on the skin and neurological system
M. avium-intracellulare–often with GI symptoms
54
Antituberculosis Medications/ Antimycobacterium
Drugs used to treat infections caused by Mycobacterium bacterial species
55
Classification Based on Drug-Susceptibility Testing
a. monoresistant - TB - resistance to one first-line anti-TB drug only
b. polydrug-resistant TB - resistance to more than one first-line anti-TB drug (other than both isoniazid and rifampicin)
c. multidrug-resistant TB (MDR-TB) - resistance to at least both isoniazid and rifampicin.
d. extensively drug-resistant TB (XDR-TB) - resistance to any fluoroquinolone and to at least one of three second-line injectable drugs (capreomycin, kanamycin, and amikacin), in addition to multidrug resistance
e. rifampicin-resistant TB (RR-TB) - resistance to rifampicin detected using phenotypic or genotypic methods, with or without resistance to other anti-TB drugs. It includes resistance to Rifampicin, whether monoresistance, multidrug resistance, polydrug resistance, or extensive drug resistance
56
RIPES stands for
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
57
MDR-TB Medications
1. Kanamycin
2. Levofloxacin
3. Prothionamide
4. Cycloserine
58
mycosis
- a term used to describe a fungal infection
- commonly, patients with weaker immune system such as organ transplant recipients, taking immunosuppressive therapy, cancer and AIDS patients are at risk
59
Four Types of Fungal Infections
1. Systemic
2. Cutaneous
3. Subcutaneous
4. Superficial
60
Dermatophytes
Fungi that cause integumentary infections
61
Antifungal drugs that are commonly used and often administered without prescription for oral and vaginal mycoses
Topical Antifungal Drugs
62
It binds to sterols in the cell membranes of the fungi
Polyenes (Amphotericin B, Nystatin)
63
Imidazoles(Ketoconazole) & Triazoles ( Fluconazole, Itraconazole, Voriconazole, Posaconazole)
combats rapidly growing fungi and inhibits fungal cell P450 enzymes
64
Echinocandins (Caspofungin, Micafungin, Anidulafungin)
prevents synthesis of glucans which are found in fungal cell walls
65
It disrupts the cellular metabolic pathways of the fungi
Anti-metabolite (Flucytosine)
66
It is the most significant protozoal disease due to high morbidity and mortality which can be transmitted through bite of an infected female anopheles mosquito which is endemic in the Philippines, blood transfusions, mother-to-child, or through the use of contaminated needles.
Malaria
67
Antimalarial drugs cannot affect the parasite during its sexual cycle (inside the mosquito) but during its asexual stage (inside the human body)
(True or False)
True
68
It is an antimalarial drug that works by inhibiting DNA and RNA polymerase and raises the pH within the parasite which interferes with the parasite’s ability to metabolize and use erythrocyte’s hemoglobin
Chloroquine and hydroxychloroquine; Mefloquine and Quinine
69
It is an antimalarial drug that binds and alters parasitic DNA
Primaquine
70
It is an antimalarial drug that inhibits dihydrofolate reductase, the enzyme needed for the production of vital substances
Pyrimethamine
71
PRIMAQUINE
The most effective antimalarial drug for eradicating the parasite during the exoerythrocytic phase is
72
Drugs such as chloroquine, pyrimethamine, quinine and mefloquine cannot prevent infection as they are only effective during the erythrocytic phase of the organisms
(True or False)
True
73
QUININE is indicated for chloroquine-resistant P. falciparum
(True or False)
True
74
Used to kill Plasmodium organisms and work during the phases of the parasite’s growth inside humans.
Antimalarial Drugs
75
Nursing Management (Antimalarial Drugs)
1. Monitor kidney and liver function
2. Take complete course.
3. Take drugs with meals to prevent GI distress
4. Report vision changes5.Avoid alcohol
6. Advise individuals traveling to endemic countries to take the prophylactic drug
7. Avoid on pregnant women
76
LIST OF MEDICINES FOR TREATMENT OF MALARIA (DOH MANUAL)
FOR UNCOMPLICATED INFECTION
1. Artemeter-Lumifantrine(AL)
2. Primaquine
FOR SEVERE MALARIA
1. Artesunate IV
2. Primaquine
3. Quinine
* Dosage calculated by weight in kg
77
Helminths
arge and complex multicellular structures
78
Drugs that are very specific with the worms they can kill, thus accurate identification of causative organisms prior to treatment is necessary
ANTI-HELMINTHIC DRUGS
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Types of Helminths (Parasitic worms)
Platyhelminths (flatworms)
Cestodes (tapeworms
Trematodes (flukes)
Nematodes (roundworms)
80
Albendazole
An antihelminthics drug that destroys the worm’s cytoplasm which immobilizes and kills the worm
81
Praziquantel
An antihelminthics drug that
increases the permeability of the cell membrane of the worm which causes dislodgement on the site of residence which they are then killed by the host.
82
Thiabendazole
An antihelminthics drug that inhibits the helminth-specific enzyme
83
Ivermectin
An antihelminthics drug that potentiates CNS of the nematode leading to paralysis
84
Pyrantel
An antihelminthics drug that blocks AChwhich results to paralysis of the worm
85
VIRUSES
Small microorganisms and replicate only inside the cells of their host which obligate intracellular parasites
86
What do you call to the mature virus particle?
Virion
87
It is a chemical that kills or suppresses the virus by either destroying virions or inhibiting their ability to replicate and are all synthetic compounds that work by inhibiting viral replication.
Antiviral Drugs
88
Even the best medications never fully eradicate a virus from its host, but the body’s immune system has a better chance of controlling the viral infection.
(True or False)
True
89
Viral illnesses are NOT difficult to eradicate 1) replicate inside host cells 2) the virus has replicated itself thousands/millions of times before symptoms appear.
(True or False)
False
90
It is a retrovirus that attaches to a host cell in order to replicate.
HIV
91
Stages of HIV Infection
Stage 1: asymptomatic infection (A few weeks to months after exposure)
Stage 2: early, general symptoms of disease (lymphadenopathy with fever, rash, sore throat, night sweats, candidiasis. The patient is termed HIV positive. May still be able to seroconvert.CD4 cells begin to drop
Stage 3: moderate symptoms –infection progresses, and opportunistic infection begins
Stage 4: severe symptoms, often leading to death –increasing destruction of helper T cells, the decline in immune function. When CD4 drops to 200 cells/mm3 below, severe opportunistic infections and other system symptoms appear.
note: Death is most likely when CD4 falls below 50 cells/mm3
92
HAART
Aggressive treatment method using three or more different medications to reduce the amount of virus and increase CD4 counts
Skipping doses or taking decreased dosages may cause medication resistance and possible treatment failure
93
HAART stands for
Highly Active Antiretroviral Therapy
94
Goals of HAART
1. Decrease viral load to undetectable levels
2. Preserve and increase the number of CD4+T cells
3. Prevent resistance
4. Have the client in good clinical condition
5. Prevent secondary infections and cancers
