Antibiotics Flashcards
what is another name for antibiotics?
antimicrobial
why is the use of antibiotics been decreasing?
to prevent resistance
what is the BEST way to prevent infection?
wash your hands
why is the use of foleys decreasing?
to prevent infection (taken out as soon as possible now)
what are ways to prevent infection?
- hygiene
- limit invasive procedures and use sterile technique
- immunization
- host defenses (physical and physiologic barriers)
what is the normal range for WBC count?
5,000-10,000
what are s/s of infection?
- fever
- increased WBC >10,000
- chills, malaise
- pus
- redness
- malodorous
- irritation
- edema
- CONFUSION
what kind of patients may not exhibit signs of infection?
elderly and immunocompromised
- might not even have a WBC count over 10,000
- might not have a fever
what is selective toxicity?
the ability of a drug to injure a target cell or target organism without injuring other cells or organisms that are in close contact with the cell
- chose a drug that is as selective as possible and will do the least damage to the host cell
what are the 3 different mechanisms of actions of the host cell?
- disrupt bacterial cell wall (bactericidal)
- inhibit the conversion of an enzyme unique to bacteria (bacteriostatic)
- disruption of protein synthesis in bacterial ribosomes (bacteriostatic)
what does bacteriostatic mean?
disrupts stasis - prevents the growth of bacteria
what does a narrow-spectrum antibiotic mean?
narrow focus and more specific to a type of bacteria (this is what we want because it causes less resistance and less damage to other cells)
what does broad-spectrum antibiotic mean?
not specific for the bug (will kill the broad type of bacteria we think it is - like gram negative or gram positive)
what is the empiric theory?
this is the process of choosing an antibiotic without identifying the type of infectious agent (would use a broad-spectrum antibiotic)
how do you match the bug to the drug?
1 - do a culture
2 - broad-spectrum antibiotic
3 - results
4 - narrow-spectrum antibiotic
what is done first, a broad-spectrum antibiotic or a culture?
culture
what is prophylactic antibiotic therapy? when is it given?
antibiotics givens when a patient is scheduled for a procedure with a strong possibility of microorganism presence
- 30-60 minutes before incision time
- possibly a couple of doses after
what kind of procedure/patient would need prophylactic antibiotics?
- surgical patients
- bacterial endocarditis - dental work with heart defects
- neutropenia
when would antibiotics not be used?
- viruses, cold, mumps, chickenpox, HIV, hyperthyroidism, autoimmune disease, a simple fever
what is one rule that is always needed when taking antibiotics?
finish out your antibiotics even if you feel better because of bacterial resistance
what does subtherapeutic mean?
antibiotic is not effective - dose is too low
what organs are antibiotics toxic to?
KIDNEYS and liver
what do bactericidal drugs do?
kills bacteria, directly lethal
what are examples of bactericidal drugs?
- penicillins (any cillins)
- cephalosporins
- vancomycin
what is the action of penicillins?
bactericidal - kills gram+ and gram- bacteria by inhibiting bacterial cell wall synthesis (weakens cell wall)
what are penicillins typically used for?
- syphilis
- meningitis
- streptococcus pneumonia
what are 2 new examples of newer penicillins?
newer stronger versions
- augmentin
- zosyn
what is a negative about penicillins?
they have been around for a while so there is a lot of resistance
what routes can penicillins be given?
IV, PO, IM
what are common side effects seen with penicillins?
minor rash to full-blown anaphylaxis
- 10% of the population is allergic (most common)
- treat with epinephrine
what are the s/s of anaphylaxis?
laryngeal edema, hypotension, bronchoconstriction
what type of patients need to be careful with the use of penicillins?
renal dysfunction patients because of kidney toxicity
what drug should not be given with penicillins?
aminoglycoside (gentamicin) - inactivates the aminoglycoside
what drug do penicillins increase the effect of?
probenecid (used for gout)
what creates an increased risk for bleeding with penicillins?
patients who are on anticoagulants
what happens if there is a mild allergic reaction to penicillins?
a patient can use cephalosporin orally
what happens if a patient has a severe allergic reaction (like anaphylaxis) to penicillins?
a patient would be considered allergic to cephalosporin
what antibiotics can a patient take if they are allergic to penicillins and cephalosporin?
vancomycin, erythromycin, clindamycin
what is the action of cephalosporins?
bactericidal - interferes with bacterial cell wall synthesis
- gram+ and gram-, some anaerobic bacteria
what kind of cephalosporins are there?
1st - 5th generation, the higher the generation the newer and more resistant (stronger) the drug is again the beta-lactamases produced by bacteria
what do cephalosporins all start with?
cef-
what are cephalosporins normally used to treat?
- streptococci
- staphylococci
what side effects are common with cephalosporins?
- mild diarrhea, abdominal cramping
- rash, pruritus, redness, edema
what do cephalosporins interfere with?
vitamin k - increased risk for bleeding
what should cephalosporins never be used with?
alcohol - disulfiram reaction
what is vancomycin?
a potentially toxic drug used only for very serious infections
what is vancomycin used for?
- gram+ bacteria
- MRSA
- Cdiff
what is the action of vancomycin?
bactericidal - interferes with bacterial cell wall synthesis
- bacterial cell lysis and death
what patient needs a lower dose of vancomycin?
a patient with renal failure
what are the adverse effects seen with vancomycin?
- renal failure
- ototoxicity
- thrombophlebitis (an inflammatory process that causes a blood clot to form and block one or more veins)
- red man syndrome
what teaching is needed with vancomycin?
an IV dose of vancomycin is given over 60 minutes to prevent thrombophlebitis and red man syndrome
what is seen with red man syndrome?
cause by an IV dose of vancomycin given to fast
- red irritating rash
- edema
- drop of BP and tachycardia
what are examples of bacteriostatic drugs?
- tetracyclines
- macrolides
- aminoglycosides (gentamicin)
what is the action of tetracyclines?
bacteriostatic - inhibits microbial protein synthesis
what are tetracyclines used for?
- chlamydia (STD)
- mycoplasma pneumonia
- rocky mountain spotted fever
- acne control
- Lyme disease
- H. pylori - associated with stomach ulcers
tetracyclines are used for what kind of alternative, allergic to what?
patients who are allergic to penicillins to treat gonorrhea and syphilis
what side effects are seen with tetracyclines?
- GI - take with food
- binds to calcium in developing teeth - don’t give to kids or pregnant women
- superinfection - an overgrowth of drug-resistant molecules (Cdiff)
- PHOTOSENSITIVITY - exaggerated sunburn
- increased BUN related to renal toxicity
what should tetracyclines not be given with?
- calcium - milk or other dairy products (teeth issues)
- magnesium
- iron
what ending is seen with tetracyclines?
-cycline
what ending is seen with macrolides?
-mycin
what is the action of macrolides?
bacteriostatic but may become bactericidal in high enough doses
are macrolides broad-spectrum or narrow-spectrum?
broad-spectrum
what are macrolides used for?
- UPPER AND LOWER RESPIRATORY INFECTIONS
- skin and soft tissue infection
- SYPHILIS
- GONORRHEA
- CHLAMYDIA
- Lyme disease
- legionella
what are the side effects of macrolides
- GI effects - take with food
- QT prolongation and sudden death (don’t take with cardiac drugs/antidysrhythmics - verapamil, diltiazem)
what drugs do macrolides increase the levels of?
- theophylline (also causes cardiac arrest)
- Tegretol (seizures)
- warfarin
what drug is an example of aminoglycosides?
- gentamicin
what is aminoglycoside (gentamicin) often used with?
vancomycin for septic
what is the action of aminoglycosides?
bacteriostatic - very potent and strong potential for toxicity (like vancomycin)
what is the use like for aminoglycosides?
- narrow-spectrum (gram-positive)
- serious infections like e. coli
are aminoglycosides narrow-spectrum or broad-spectrum?
narrow-spectrum (gram-positive)
what are the side effects of aminoglycosides?
like vancomycin
- ototoxicity
- nephrotoxicity
what drug interaction is there with aminoglycosides?
increased risk for renal failure when administered with other nephrotoxic drugs?
- cephalosporin
- vancomycin
- NSAIDS
what are trough and peak levels?
- nurses responsibility to coordinated
- used for toxic antibiotics to see if the dose is high or low
- trough is the lowest level, taken right before the next dose
- peak - couple hours after the dose
- if the trough is too high that can mean overdose
- if the trough is too low that could mean ineffective
what is the action of sulfonamides?
bacteriostatic - inhibit the synthesis of folic acid that bacteria needs to make RNA and DNA
who should not take sulfonamides?
people with a sulfa allergy
what are sulfonamides used for?
UTIs (E. coli)
what adverse effects are seen with sulfonamides?
- hypersensitivity reactions
- hemolytic anemia
- steven johnson syndrome
what is the action of fluoroquinolones?
bactericidal, very potent broad-spectrum antibiotic
what is the use of fluoroquinolones?
- gram-negative
- lower respiratory infections
- bone and joint infections
- infectious diarrhea
- UTIs
- skin infection
what is the common ending of fluoroquinolones?
-floxacin
what are the adverse effects of fluoroquinolones?
- nausea
- constipation
- abdominal pain
- fever
- chills
- blurred vision
- headache
- dizziness
- fatigue
- pseudomembranous colitis
- GI
what are the drug interactions with fluoroquinolones?
- antacids/Carafate decreases the effectiveness of fluoroquinolones
- increased toxic levels of theophylline when given with fluoroquinolones
- increased risk of bleeding with anticoagulants
what is the action of metronidazole (Flagyl)?
bacteriocidal - a primary drug for CDIFF
what is metronidazole (Flagyl) used to treat?
protozoa - a primary drug for CDIFF
what route is metronidazole (Flagyl) given?
PO because CDIFF is in the GI tract
what are the side effects of metronidazole (Flagyl)?
- NVD
- may turn urine dark reddish-brown
- don’t drink alcohol - disulfiram reaction
what are 2 examples of antifungal drugs?
- amphotericin B
- nystatin
what is amphotericin B used for
- antifungal
- often seen in the ICU, not a pleasant med
- broad-spectrum
- dangerous
- only used for potentially fatal fungal infections
what is Nystatin used for?
- used only to treat candidiasis (often seen with chemo or corticosteroids)
what is the route for Nystatin?
- topically or orally
how is Nystatin given for oral candidiasis?
swish and swallow
