Antibiotic therapy and Antibiotics Affecting Cell Wall

Question 1

What are some examples of gram- positive bacteria?

Answer 1

staph, strep, and enterococci

Question 2

What are some examples of gram-negative bacteria?

Answer 2

E. coli, pseudomonas, salmonella

Question 3

Why is culture and sensitivity testing so important before administering antibiotic therapy?

Answer 3

By identifying the microorganisms present in the infection and what antibiotic they are sensitive to we can prescribe the best antibiotic to eradicate the infection.

Question 4

What does it mean that there is no antibiotic developed yet that is selectively toxic?

Answer 4

This means that an antibiotic that only attacks one type of microorganism has not been invented yet, so all of them have some affect to the hosts cells (normal flora). So they can end up attacking our normal flora MAINLY in our mouth, GI tract, and vagina. This can lead to what is called SUPRAINFECTIONS.

Question 5

what is a broad-spectrum antibiotic? What are patients on these at a higher risk for?

Answer 5

kills a large variety of different bacteria

They are at a higher risk for suprainfections because they kill more of our normal flora.

Question 6

What is a narrow-spectrum antibiotic? Is there a risk for suprainfections with these?

Answer 6

These kill a smaller variety of bacteria

There is a much lower risk for suprainfections with these.

By being able to identify specific antigens and having the ability to prescribe an antibiotic that is more specific to that bacteria the risk for suprainfections can be drastically lowered.

Question 7

What are bacteriocidal antibiotics?

Answer 7

These antibiotics kill bacteria

Question 8

What are bacteriostatic antibiotics?

Answer 8

These slow the growth of the bacteria allowing for the hosts own immune system to destroy the bacteria.

Question 9

Are there some situations where a culture and sensitivity cant be done in time and the patients may need to be started on broad spectrum antibiotics before the pathogen is identified? What are the risks with this?

Answer 9

YES YES YES

this will increase the patients risk for a suprainfection

Question 10

What is a key thing to do when taking a culture and sensitivity?

Answer 10

PREVENT CONTAMINATION, if contaminated an inaccurate result may

Question 11

What is culture and sensitivity exactly? What is the best time to obtain this?

Answer 11

This is when a sample of the bacteria is obtained and cultured to grow, once the bacteria have colonized they are checked for sensitivity to certain antibiotics.

the best time to obtain this is before antibiotic therapy is started

Question 12

So in a scenario where someone is transferred to the unit with a prescription for an antibiotic and culture and sensitivity to be taken, what should the nurse do?

Answer 12

Hold the antibiotic until the culture and sensitivity has been taken and reported before antibiotics are administered, if it is practical. This means that a culture and sensitivity must be done in a timely manner. However, sometimes antibiotics will be ordered to be administered before culture and sensitivities are done or reported back.

Question 13

what are some factors that affect antibiotic therapy?

Answer 13

immunocompromised - may need strong bacteriocidals (even ones reserved for severe infections)

sites of infection (brain & CSF are hard to treat because of BBB…. infected skin lesion with poor circulation)

age - infants/older adults have an increased risk for toxicity (impaired metabolism and excretion…kidney and liver function)

Pregnancy - many are pregnancy category D (gentamicin and tetracyclines)

breastfeeding - avoid while on antibiotics

Question 14

Describe acquired resistance.

Answer 14

drug resistant bacteria/big in nosocomial infections (strong bacteria that arent killed in hospital setting live to become resistant)

NEED TO TAKE REQUIRED DOSE FOR FULL REGIME, only weak ones destroyed, strong one lives to grow and become resistant

Question 15

Why was vancomycin created?

Answer 15

Vancomycin was created due to methicillin resistant staphylococcus aureus (MRSA) and drug resistance in penicillin and cephalosporins

Question 16

Is there a bacteria that is resistant to vancomycin?

Answer 16

YES YES YES

vancomycin resistant enterococci (VRE)

Question 17

What is the best way to prevent resistance to antibiotics?

Answer 17

doses should be high enough and for a long enough duration to kill ALL microorganisms (not just the weak ones)

Patient teaching is important!

Combo drugs can help!

Question 18

What is THE USUAL patient teaching for ALL antibiotics?

Answer 18

dont stop even if you feel better! Take the entire prescribed dose regime

Go to the ED if you experience signs of allergic or hypersensitivity reaction (difficulty breathing, rash, difficulty swallowing)

drink lots of fluids (help flush kidneys, also ill patients need hydration anyways)

Watch for signs of suprainfections - vaginal, mouth, GI (call provider)

dont share medication with other people

small, frequent meals could help with GI effects

keep out of reach of children

report signs of allergic reaction - rash, urticaria

Question 19

What is the therapeutic response of penicillins?

Answer 19

bacteriocidal by disrupting the bacterial cell wall when dividing; drug of choice for gram-positive

Question 20

What are penicillins the drug of choice for?

Answer 20

gram-positive bacteria

Question 21

What are penicillins used as prophylaxis against?

Answer 21

bacterial endocarditis in at-risk clients prior to dental and other procedures.

Question 22

What are some adverse effects of penicillins?

Answer 22

allergic reactions (HIGH HYPERSENSITIVITY RISK)

renal impairment (high doses)

hyperkalemia/dysrhythmias with high doses

cross-sensitivity reaction with cephalosporins (chance of being allergic to chephalosporins if allergic to penicillin and the other way around, (10-20% of population))

Question 23

What are some nursing considerations for penicillin?

Answer 23

observe clients for 30 minutes after administration (allergic reactions)

monitor for renal impairment

monitor potassium levels and EKG with higher doses - hyperkalemia/dysrhythmias

probenacid (Probalan) (antigout) - delays excretion of penicillin (can be used if not enough penicillin for full dosage regime to increase therapeutic effectiveness time of smaller dose of penicillin by delaying excretion)

Question 24

What are some patient teaching points for penicillins?

Answer 24

THE USUAL

take with a full glass of water one hour before or two hours after a meal

Allergic reactions are common - report rash, pruritis, difficulty breathing/swallowing

Question 25

What is the therapeutic action of cephalosporins?

Answer 25

bacteriocidal and bacteriostatic depending on the dose used and specific drug; by inhibiting bacterial cell wall synthesis; different generations are effective against different bacteria; BROAD SPECTRUM (RISK FOR SUPRAINFECTIONS)

Question 26

What are some adverse effects of cephalosporins?

Answer 26

cross-sensitivity with penicillins (same as described in penicillin card)

allergic reactions

pain at IM site (inject deep IM) or thrombophlebitis at IV site (be sure it is diluted, large bore, larger vein (not usually central line))

suprainfections!!! - AAPMC (antibiotic associated pseudomembranous colitis)

bleeding tendencies (cefotetan and ceftriaxone)

Question 27

what are some nursing considerations for cephalorsporins?

Answer 27

monitor for allergic reactions

Inject deep IM (IM site pain) and make sure solution is diluted (thrombophlebitis at IV site)

monitor for diarrhea and report (AAPMC)

avoid taking with other anticoagulants (cefotetan and ceftriaxone bleeding tendencies)

Question 28

What are some patient teaching points for cephalosporins?

Answer 28

THE USUAL

avoid alcohol for 72 hours after discontinuing the drug - disulfuram reaction (similar to reaction of antabuse (bad hangover feeling))

take with food and keep oral suspension in fridge

avoid taking with anticoagulants (cefotetan and ceftriaxone)

Question 29

What are the general adverse reactions that can happen with antibiotics?

Answer 29

kidney damage - especially aminoglycosides, vancomycin

GI toxicity - diarrhea, n/v (ALL CAN DO THIS, BROAD SPECTRUM ESPECIALLY)

hepatotoxicity

neurotoxicity - especially in aminoglycosides and vancomycin

hypersensitivity reactions - (ALL, ESPECIALLY PENICILLIN) most important question to ask if what exactly happens when the drug is taken (making sure it is suggestive of actual allergy, urticaria, rash, anaphylaxis)

Suprainfections (normal flora destroyed) - thrush infections, diarrhea, vaginal yeast infections, AAPMC (c. diff.. causes mucous/pus (sometimes blood) and watery diarrhea with a distinct odor)

Question 30

Why would antibiotics be prescribed prophylactically?

Answer 30

before procedures (for example GI surgery)

Question 31

What is the nurses role in prevention of infections?

Answer 31

hand washing

advocate use of antibiotics only when necessary (contributes to cause of suprainfections)

keep central line dressing clean, dry, intact, and change per protocol (if dressing comes up and no longer has a good seal and cant be brought back down on skin the dressing needs changed)

good hygiene with catheters

observe infection control principles

• – sterile technique
• – clean equipment
• – observe isolation requirements
• – consider nurse assignments (bad idea for a nurse to have a MRSA patient and an immediate post-op patient in the same shift)

patient teaching when prescribing antibiotics is important (THE USUAL)

Question 32

What is the therapeutic action of carbapenems?

Answer 32

bacteriocidal that inhibits bacterial cell wall synthesis - BROAD SPECTRUM (RISK FOR SUPRAINFECTIONS) - RESERVED FOR SERIOUS INFECTIONS

Question 33

What are some adverse effects/nursing considerations of carbapenems?

Answer 33

cross-sensitivity with penicillins/cephalosporins - not as prevalent

allergic reactions - monitor

GI - n/v - monitor and report

SUPRAINFECTIONS - monitor for colitis, diarrhea, oral thrush, vaginal yeast infections

drug-drug interaction with valproic acid - reduces blood levels of valproic acid making them more susceptible to seizures

Question 34

What are some patient teaching points for carbapenems?

Answer 34

THE USUAL

take as directed and report signs of suprainfections

Question 35

What is the therapeutic action of vancomycin?

Answer 35

bacteriocidal affecting cell wall synthesis

Question 36

What are some adverse effects/nursing considerations/patient teachin of vancomycin?

Answer 36

nephrotoxicity - monitor and report

ototoxicity - monitor and report

red-man syndrome - infusion reaction (rash, flushing, tachycardia, hypotension) - administer over 60 minutes

thrombophlebitis - administer slowly, central line is best, large bore IV

Question 37

What infections is vancomycin reserved for usually?

Answer 37

severe infections like MRSA and AAPMC

Question 38

Does vancomycin have a narrow therapeutic range?

Answer 38

YES YES YES

Question 39

After how many doses are peaks and trough drawn for vancomycin? Why? When are they drawn?

Answer 39

usually after 3 doses

peak: 30 minutes after IV administration
trough: right before next dose

This is to make sure that the patient stays in therapeutic range while keeping out of toxic range

Question 40

How is vancomycin administered?

Answer 40

slowly over 60 minutes IV - monitor for red-man syndrome and thrombophlebitis