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STUDY CARDS > ANTIBIOTICS > Flashcards

ANTIBIOTICS Flashcards

1
Q

Bacteria

A

Gram positive
Gram negative

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2
Q

Infections

A

Community-acquired infection

Health care–associated infections

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3
Q

Community-acquired infection

A

An infection that is acquired by a person who has not been hospitalized (within the past year) or had a medical procedure (e.g., dialysis, surgery, catheterization) within the past year

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4
Q

Health care–associated infections

A

Contracted in a health care facility

Were not present or incubating in the patient on admission to the facility

Occurs more than 48 hours after admission

One of the top 10 causes of death in Canada

More difficult to treat because causative microorganisms are often drug resistant and the most virulent

Methicillin-resistant Staphylococcus aureus (MRSA) (most common) and vancomycin-resistant enterococcus(VRE)

Previously known as nosocomial infection

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5
Q

Health Care–Associated Infections: Prevention

A

Handwashing: the single most important prevention method

Antiseptics

Disinfectants

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6
Q

Disinfectant

A

Kills organisms

Used only on nonliving objects

Cidal agent

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7
Q

Antiseptic

A

Generally only inhibits the growth of microorganisms; does not necessarily kill them

Applied exclusively to living tissue

Static agents

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8
Q

Bactericidal

A

kills bacteria

aminoglycosides
beta-lactams
vancomycin
quinolones
rifampin
metronidazole

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9
Q

Bacteriostatic

A

prevents bacteria growth

chloramphenicol
erythromycin
clindamycin
sulfonamides
trimethoprim
tetracycline

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10
Q

Antibiotics

A

Medications used to treat bacterial infections

Ideally, before beginning antibiotic therapy, the suspected areas of infection should be cultured to identify the causative organism and potential antibiotic susceptibilities

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11
Q

Emperic therapy

A

treatment of an infection before specific culture information has been reported or obtained

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12
Q

Definitive therapy

A

antibiotic therapy tailored to treat organism identified with cultures

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13
Q

Prophylactic therapy

A

treatment with antibiotics to prevent an infection, as in intra-abdominal surgery or after trauma

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14
Q

Therapeutic response

A

Decrease in specific signs and symptoms of infection are noted (fever, elevated white blood cell count, redness, inflammation, drainage, pain).

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15
Q

Subtherapeutic response

A

Signs and symptoms of infection do not improve.

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16
Q

Antibiotic Therapy Indication

A

Superinfection

Pseudomembranous colitis:

Clostridium difficile

Secondary infection

Resistance

Antimicrobial stewardship (Accreditation Canada, 2014)

Food–drug interactions

Glucose-6-phosphate dehydrogenase (G6PD) deficiency and slow acetylation

Pregnancy-related host factors

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17
Q

Two abx families that causes severe allergic reactions

A

Penicillins and sulfonamides are two broad classes of antibiotic to which many people have allergic anaphylactic reactions.

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18
Q

Antibiotic’s most common severe reactions

A

difficulty breathing; significant rash, hives, or other skin reaction; and severe gastrointestinal (GI) intolerance

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19
Q

Host factors

A

age, allergies, kidney and liver function, pregnancy status, genetic characteristics, site of infection and host defences

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20
Q

Antibiotics: 8 Classes

A

Sulfonamides

Penicillins

Cephalosporins

Carbapenems

Macrolides

Aminoglycosides

Tetracyclines

Quinolones

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21
Q

Antibiotic Therapy: Mechanism of Action

A

Interference with cell wall synthesis

Interference with protein synthesis

Interference with deoxyribonucleic acid (DNA) replication

Acts as a metabolite to disrupt critical metabolic reactions inside the bacterial cell

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22
Q

Actions of Antibiotics

Bactericidal vs Bacteriostatic

A

Bactericidal (kill bacteria)

Bacteriostatic (inhibit growth of susceptible bacteria rather than killing them immediately; eventually leads to bacterial death)

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23
Q

Antibiotics: Sulfonamides

A

One of the first groups of antibiotics

Often combined with another antibiotic

Sulfamethoxazole combined with trimethoprim (a nonsulfonamide antibiotic) (Apo-Sulfratrim®, Protrim®, Teva-Trimel®, Septra®) and often abbreviated as SMX-TMP, is used commonly in clinical practice.

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24
Q

Sulfonamides: Mechanism of Action

A

Bacteriostatic action

Prevent synthesis of folic acid required for synthesis of purines and nucleic acid

Do not affect human cells or certain bacteria; can use preformed folic acid

Only affect organisms that synthesize their own folic acid

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25
Q

Sulfonamides:

Indications

effective againts which bacteria

A

Effective against both gram-positive and gram-negative bacteria

Treatment of urinary tract infections caused by susceptible strains of Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Proteus vulgaris, Staphylococcus aureus

Pneumocystis jiroveci pneumonia
sulfamethoxazole/trimethoprim (SMX-TMP)

Upper respiratory tract infections

SMX-TMP is commonly used for outpatient Staphylococcus infections because of the high rate of community-acquired MRSA infections.

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26
Q

Sulfonamides: Contraindications

A

with celoxicib (Celebrex) if have known sulfonamide allergy

in pregnant women and infants younger than 2 months

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27
Q

Sulfonamides: Interactions

A

Sulfonamide + sulfonylureas = increased hypoglycemic effects

Sulfonamide + Phenytoin = toxicity of phenytoin (seizure med)

Sulf + Warfarin = increased bleeding

Sulf + cyclosporine = nephrotoxicity

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28
Q

Sulfonamides: Adverse Effects

Blood

Integumentary

GI

Other

A

Blood: Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia

Integumentary: Photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrolysis

GI: Nausea, vomiting, diarrhea, pancreatitis, hepatotoxicity

Other: Convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria, cough

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29
Q

Sulfonamides nursing consideration

A

Take with plenty of fluids to avoid crystalluria or precipitation in the kidneys

Take with food

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30
Q

ß-Lactam Antibiotics

A

Penicillins
Cephalosporins
Carbapenems
Monobactams

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31
Q

Penicillins 4 types

A

Natural penicillins
Penicillinase-resistant penicillins
Aminopenicillins
Extended-spectrum penicillins

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32
Q

2 Natural penicillins

A

penicillin G
penicillin V

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33
Q

Penicillinase-resistant drugs

A

cloxacillin sodium

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34
Q

Aminopenicillins

A

amoxicillin
ampicillin

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35
Q

Some bacteria developed the capacity to destroy penicillins which led to the advent of

A

β lactamase inhibitors

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36
Q

Two β lactamase inhibitors

A

Clavulanic acid (clavulanate)

tazobactam

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37
Q

Extended-spectrum drugs

A

piperacillin sodium/tazobactam sodium (Tazocin)

piperacillin sodium
clavulanic potassium/ticarcillin disodium

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38
Q

Penicillins: Mechanism of Action

A

Penicillins enter the bacteria via the cell wall.

Inside the cell, they bind to penicillin-binding protein.

Once they are bound, normal cell wall synthesis is disrupted.

As a result, bacteria cells die from cell lysis.

Penicillins do not kill other cells in the body.

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39
Q

Penicillins: Indications

A

Prevention and treatment of infections caused by susceptible bacteria, such as:

Gram-positive bacteria, including Streptococcus spp., Enterococcus spp., and Staphylococcus spp.

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40
Q

Penicillins: Contraindications and Concerns

A

Usually safe and well-tolerated medications

Known medication allergy

Type of reaction that occurs in patients who state they are allergic to penicillins

Many medication errors have occurred when a penicillin drug called by its trade name is given to a patient with a penicillin allergy.

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41
Q

Penicillin naming

A

Not all names end in “cillin” (e.g., Clavulin® A,). Combination of amoxicillin and clavulanic acid)

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42
Q

Penicillins: Adverse Effects

A

Common adverse effects:
Nausea, vomiting, diarrhea, abdominal pain

Allergic reactions to the penicillins occur in 0.7% to 4% of treatment courses.
-Urticaria, pruritus, angioedema

Patients allergic to penicillins have an increased risk of allergy to other ß-lactam antibiotics.

Only patients with a history of throat swelling or hives from penicillin should not receive cephalosporins.

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43
Q

Penicillins: Interactions

A

Many interactions!

NSAIDs compete for protein binding (increased effect of penicillin)

Oral contraceptives (decreased effect)
Potassium supplements (worsen hyper K+)

Probenecid (prolongs penicillin effect)

Rifampin (inhibit killing activity of penicillin)

Warfarin (enhances anticoag effect)

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44
Q

Avoid taking oral PEN form with

A

caffeine, citrus fruit/juice, tomato juice, colas

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45
Q

Cephalosporins

A

First generation
Second generation
Third generation
Fourth generation
Fifth generation (none available in Canada)

Semisynthetic antibiotics
Structurally and pharmacologically related to penicillins
Bactericidal action
Broad spectrum
Divided into groups according to their antimicrobial activity

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46
Q

Cephalosporins: First Generation

A

Good gram-positive coverage
Poor gram-negative coverage
Parenteral and oral forms

Example
cephalexin (Keflex®)
cefazolin

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47
Q

Cephalosporins: First Generation

Used for surgical prophylaxis and for susceptible staphylococcal infections

A

cefazolin: intravenous (IV) or intramuscular (IM)

cephalexin (Keflex): oral dosage

48
Q

Cephalosporins: Second Generation

A

Good gram-positive coverage

Better gram-negative coverage than
first- generation cephalosporins

Examples

cefoxitin
cefuroxime

cefaclor
cefprozil

49
Q

Cephalosporins: Second Generation

cefoxitin (Mefoxin®): IV and IM

TWO

A

Used prophylactically for abdominal or colorectal surgeries

Also kills anaerobes

50
Q

Cephalosporins: Second Generation

cefuroxime

TWO

A

cefuroxime axetil (Ceftin®) is oral form

Surgical prophylaxis

Does not kill anaerobes

51
Q

Cephalosporins: Third Generation

A

Most potent group against gram-negative bacteria

Less active against gram-positive bacteria

Examples

ceftazidime
ceftriaxone

cefotaxime sodium
cefixime
cefpodoxime proxetil
ceftizoxime

52
Q

Cephalosporins: Third Generation

ceftriaxone sodium

A

IV and IM, long half-life, once-a-day dosing

Elimination is primarily hepatic

Easily passes meninges and diffused into cerebrospinal fluid to treat central nervous system infections

53
Q

Cephalosporins: Third Generation

ceftazidime (Fortaz®)

A

IV and IM forms

Excellent gram-negative coverage

Used for difficult-to-treat organisms such as Pseudomonas spp.

Excellent spectrum of coverage

Resistance is limiting usefulness.

54
Q

Cephalosporins: Fourth Generation

A

Broader spectrum of antibacterial activity than third-generation cephalosporins, especially against gram-positive bacteria

Uncomplicated and complicated urinary tract infection

cefepime hydrochloride (Maxipime®)

55
Q

Cephalosporins: Adverse Effects

A

Similar to those of penicillins

Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema

Potential cross-sensitivity with penicillins if allergies exist

56
Q

Carbapenems

A

Broadest antibacterial action of any antibiotics to date

Reserved for complicated body cavity and connective tissue infections in acutely ill hospitalized patients

Must be infused over 60 minutes

May cause drug-induced seizure activity

This risk can be reduced with proper dosage.

57
Q

1 drug of Carbapenems

A

imipenem/cilastatin (Primaxin®)

meropenem (Merrem®)
ertapenem (Invanz®)

58
Q

imipenem/cilastatin (Primaxin®)

Used for?

Cilastatin

A

Used for treatment of bone, joint, skin, and soft tissue infections; many other uses

Cilastatin inhibits an enzyme that breaks down imipenem.

59
Q

Monobactams

A

aztreonam (Cayston®)

Synthetic ß-lactam antibiotic

Primarily active against aerobic gram-negative bacteria (E. coli, Klebsiella spp., Pseudomonas spp.)

Bactericidal

Parenteral use only

Used for management of cystic fibrosis patients with chronic pulmonary Pseudomonas aeruginosa infections

60
Q

3 Macrolides

A

erythromycin (E-Mycin®, many others)
azithromycin (Zithromax®)
clarithromycin (Biaxin®)

fidaxomicin (Dificid®)

61
Q

Macrolides:Mechanism of Action

A

Prevent protein synthesis within bacterial cells

Considered bacteriostatic

Bacteria will eventually die

In high enough concentrations, may also be bactericidal

62
Q

Macrolides: Indications

A

“Strep” infections
-Streptococcus pyogenes (group A ß-hemolytic streptococci)

Mild to moderate upper and lower respiratory tract infections
-Haemophilus influenzae

Spirochetal infections
-Syphilis and Lyme disease

Gonorrhea, Chlamydia, Mycoplasma

63
Q

Macrolides

Fidaxomicin (Dificid):

Indicated only for the treatment of

A

newest macrolide

The most common adverse effects are nausea, vomiting, and GI bleed.

Indicated only for the treatment of C. difficile–associated diarrhea

Reasonably safe for use in pregnancy

Minimal absorption

64
Q

Macrolides: Adverse Effects

erythromycin

azithromycin and clarithromycin:

A

GI effects, primarily with erythromycin
Nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia, heartburn, abnormal taste.

fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration

65
Q

2 Tetracyclines

A

doxycycline hyclate (Doxycin®, Vibramycin®, others)

tigecycline (Tygacil®)

minocycline hydrochloride (Minocin®)

66
Q

Tetracyclines

Obtained from cultures of

Action

A

Natural and semisynthetic

Obtained from cultures of Streptomyces

Bacteriostatic: inhibit bacterial growth

Inhibit protein synthesis

Stop many essential functions of the bacteria

67
Q

What reduces absorption of tetracyclines?

A

Dairy products, antacids, and iron salts reduce oral absorption of tetracyclines.

68
Q

Tetracyclines binds to?

A

Bind (chelate) to Ca+++ and Mg++ and Al+++ ions to form insoluble complexes

69
Q

Do not use Tetracyclines in?

A

Should not be used in children younger than 8 years of age or in pregnant or lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth

70
Q

Tetracyclines: Indications

A

Wide spectrum

Gram-negative and gram-positive organisms, protozoa, Mycoplasma spp., Rickettsia spp., Chlamydia, syphilis, Lyme disease, acne, others

71
Q

Tetracyclines: Adverse Effects

Strong affinity for?

A

calcium

preludes use in…

Children younger than 8 years of age
Results in discolouration of permanent teeth

Pregnant women and nursing mothers
can be another route of exposure leading to tooth discoloration in nursing children

May stunt fetal skeletal development if taken during pregnancy

72
Q

Tetracyclines: Adverse Effects

A

Alteration of the intestinal flora

May also cause:
Vaginal candidiasis
Gastric upset
Enterocolitis
Maculopapular rash

73
Q

Nursing Implications

A

Before beginning therapy, assess drug allergies; renal, liver, and cardiac function; and other laboratory studies.

Be sure to obtain a thorough patient health history, including immune status.

Assess conditions that may be contraindications to antibiotic use or that may indicate cautious use.

Assess potential drug interactions.

Monitor adverse reactions.

Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better.

Watch for for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge.

For safety reasons, check the name of the medication carefully, because there are many drugs that sound alike or have similar spellings.

Each class of antibiotics has specific adverse effects and drug interactions that must be carefully assessed and monitored.

The most common adverse effects of antibiotics are nausea, vomiting, and diarrhea.

All oral antibiotics are absorbed better if taken with at least 180 mL of water.

74
Q

It is essential to obtain ____ from appropriate sites before beginning antibiotic therapy.

A

cultures

75
Q

Sulfonamides Nursing Implications

A

Take with 2 000 to 3 000 mL of fluid per 24 hours.

Take oral doses with food.

Encourage patients to immediately report worsening abdominal cramps, stomach pain, diarrhea, hematuria, severe or worsening rash, shortness of breath, and fever.

76
Q

Penicillins Nursing Implications

A

Take oral doses with water (not juices) because acidic fluids may nullify the drug’s antibacterial action.

Monitor patients taking penicillin for an allergic reaction for at least 30 minutes after administration.

77
Q

Cephalosporins Nursing Implications

A

Assess for penicillin allergy; patient may have cross-allergy.

Give orally administered forms with food to decrease GI upset even though this will delay absorption.

Some of these drugs may cause a disulfiram (acute alcohol intolerance) reaction when taken with alcohol.

78
Q

Macrolides Nursing Implications

A

These drugs are highly protein bound and will cause severe interactions with other protein-bound drugs.

The absorption of oral erythromycin is enhanced when the medication is taken on an empty stomach. However, because of the high incidence of GI upset, many medications are taken after a meal or snack.

79
Q

Tetracyclines Nursing Implications

A

Avoid milk products, iron preparations, antacids, and other dairy products because of the chelation and drug binding that occur.

Take all medications with at least 180 mL of fluid, preferably water.
Because of photosensitivity, avoid sunlight and tanning beds.

80
Q

Monitor therapeutic effects.

A

Improvement of signs and symptoms of infection
Return to normal vital signs
Negative culture and sensitivity tests
Disappearance of fever, lethargy, drainage, and redness

81
Q

Multidrug-Resistant Organisms

A

Organisms that are resistant to one or more classes of antimicrobial drugs

Methicillin-resistant Staphylococcus aureus (MRSA)

Vancomycin-resistant Enterococcus (VRE)

Organisms producing extended-spectrum ß-lactamases (ESBLs)

Organisims producing Klebsiella pneumoniae carbapenemase (KPC)

Newer antibiotics have been developed to successfully treat VRE and MRSA.

82
Q

MRSA

A

Threat of MRSA becoming resistant to all antibiotics currently available

No longer seen just in hospitals. It has spread to the community setting, and approximately 50% of staphylococcal infections contracted in the community involve MRSA.

83
Q

VRE

A

usually seen in urinary tract infections (UTIs)

84
Q

Extended-spectrum ß-lactamases (ESBL)

A

Organisms that produce ESBL are resistant to all ß-lactam antibiotics and aztreonam.

Can be treated only with carbapenems or sometimes quinolones

Use of carbapenems: resistance occurred; bacteria created a new means of resistance known as

Klebsiella pneumoniae carbapenemase
tigecycline and colistimethate sodium

85
Q

Aminoglycosides

A

Natural and semisynthetic

Several routes available but not given orally because of poor oral absorption

Very potent antibiotics with serious toxicities

Bactericidal; prevent protein synthesis

Kill mostly gram-negative bacteria, some gram-positive bacteria

86
Q

Aminoglycosides medications

A

gentamicin sulphate
tobramycin sulphate
neomycin sulphate

streptomycin sulphate
amikacin sulphate
paromomycin sulphate

87
Q

Aminoglycosides: Indications

A

Used to kill gram-negative bacteria such as Pseudomonas spp., Escherichia coli, Proteus spp., Klebsiella spp., Serratia spp.

Often used in combination with other antibiotics for synergistic effects
Used for certain gram-positive infections that are resistant to other antibiotics such as Enterococcus spp.,

S. aureus, and bacterial endocarditis, which is usually streptococcal in origin

88
Q

Aminoglycosides: Indications

A

Most often given parenterally

neomycin sulphate
-Topical antibacterial

gentamicin
Available in injections, topical ointments, and ophthalmic drops and ointments

89
Q

Aminoglycosides: Adverse Effects

A

Serious toxicities
-Nephrotoxicity (kidney damage)
-Ototoxicity (auditory impairment and vestibular impairment [eighth cranial nerve])

Must monitor drug levels to prevent toxicities

Minimum inhibitory concentration

Other less common effects:
Headache
Paresthesia
Fever
Vertigo
Skin rash
Overgrowth of nonsusceptible organisms
Neuromuscular paralysis (very rare and reversible)

90
Q

Ototoxicity

A

ear poisoning

damages a person’s inner ear or auditory nerve

can be permanent

symptoms: ear fullness, unsteadiness, unable to tolerate head movement

91
Q

Nephrotoxicity

A

kidney toxicity

reversible upon d/c of drug

symptoms: not noticeable, or decrease urination, thirst increased HR, dizziness, and decreased appetite

92
Q

Aminoglycosides

A

Therapeutic drug monitoring required

93
Q

Aminoglycosides: Therapeutic Drug Monitoring

A

Serum levels measured to prevent toxicity

Serum level needs to be higher than the minimum inhibitory concentration to kill the bacterial.

Time-dependent killing

Concentration-dependent killing

Postantibiotic effect

Resistance

Drug interactions

94
Q

Aminoglycosides: Therapeutic Drug Monitoring

Peak & Trough

A

Peak: highest drug levels for once-daily regimens

Trough: lowest, to ensure adequate renal clearance of the drug and avoid toxicity

95
Q

Aminioglycosides Interactions

A

Concurrent use of nephrotoxic drugs increase nephrotoxicity

-vancomycin, cylcosporine, amphotericin B

Loop diuretics increase risk for ototoxicity

Increased effect of warfarin/warfarin toxicity

96
Q

Aminoglycosides Nursing Considerations

A

Plenty of fluids up to 3000mL/day

Consumption of probiotic type foods

Monitor peak and trough levels

Peak for gentamicin & tobramycin
5-10 mcg/mL

Trough for gentamicin & tobramycin
Less than 2 mcg/mL

97
Q

Quinolones

A

Also called fluoroquinolones

Excellent oral absorption, except for norfloxacin hydrochloride

Absorption reduced by antacids, calcium, magnesium, iron, others

Effective against gram-negative organisms and some gram-positive organisms

98
Q

Quinolones drugs

A

ciprofloxacin (Cipro®)*
levofloxacin (Levaquin®)*

norfloxacin hydrochloride (Apo-Norflox®)
moxifloxacin hydrochloride (Avelox®)

99
Q

Quinolones is not recommended in?

A
  • Not normally recommended for children less than 18 years of age because of adverse MSK effects
100
Q

Quinolones: Mechanism of Action

A

Bactericidal

Alter deoxyribonucleic acid (DNA) of bacteria, causing death

Do not affect human DNA

Used to treat S. aureus, Serratia marcescens, and
Mycobacterium fortuitum

Bacterial resistance to quinolone antibiotics: Pseudomonas aeruginosa, S. aureus, Pneumococcus spp., Enterococcus spp., and the broad Enterobacteriaceae family that includes E. coli.

101
Q

Quinolones: Indications

A

Gram-negative and gram-positive bacteria
Complicated urinary tract, respiratory, bone and joint, gastrointestinal, and skin infections
ciprofloxacin and levofloxacin, both oral and injection
norfloxacin hydrochloride has limited oral absorption and is available only in oral form, so its use is limited to genitourinary infections.

102
Q

fluoroquinolones

A

PO/ IV

infections of bone, joint, soft tissues, ophthalmic, resp, GI, abd, prostate, UTIs, STDs

inhibits DNA gyrase and topoisomerase

bactericidal

103
Q

Quinolones: Interactions

A

Oral quinolones: antacids, calcium, magnesium, iron, zinc preparations, or sucralfate
Patients need to take the interacting drugs at least 1 hour before or after taking quinolones.
Dairy products
Enteral tube feedings
probenecid
nitrofurantoin
Oral anticoagulants

104
Q

Quinolones: Adverse Effects

A

Body system/adverse effects

Central nervous: Headache, dizziness, insomnia, depression, restlessness, convulsions

Gastrointestinal: Nausea, vomiting, diarrhea, constipation, oral candidiasis, dysphagia, increased liver function study results, others

Integumentary: Rash, pruritus, urticaria, flushing

Other: Ruptured tendons, tendonitis, fever, chills, blurred vision, tinnitus

104
Q

Quinolones HC warning

A

*Health Canada warning: increased risk of tendonitis and tendon rupture

105
Q

Miscellaneous Antibiotics

A

clindamycin (Dalacin C®)
metronidazole (Flagyl®)
vancomycin hydrochloride (Vancocin®)

linezolid (Zyvoxam®)
nitrofurantoin (MacroBID®, Furantoin®)
quinupristin and dalfopristin (Synercid®)
colistimethate sodium (Coly-Mycin®)

106
Q

clindamycin (Cleocin®)

A

Used for chronic bone infections, genitourinary infections, intra-abdominal infections, other serious infections

May cause pseudomembranous colitis (also known as antibiotic-associated colitis, Clostridium difficile diarrhea, or C. difficile infection)

Potential interaction with vecuronium bromide

107
Q

linezolid (Zyvoxam)

A

New class: oxazolidinones

Used to treat vancomycin-resistant Enterococcus faecium (commonly referred to as VRE), hospital-acquired, and skin structure infections, including infections with MRSA

Strengthens effects of vasopressive drugs, serotonin syndrome if taken with selective serotonin reuptake inhibitors (SSRIs), and reactions if taken with tyramine-containing foods

108
Q

metronidazole (Flagyl)

A

Used for anaerobic organisms

Intra-abdominal and gynecological infections

Protozoal infections

Several drug interactions

109
Q

nitrofurantoin (Furantoin, MacroBID)

A

Primarily used for UTIs (E. coli, S. aureus,

Klebsiella spp., Enterobacter spp.)

Use carefully if kidney function is impaired.

Drug concentrates in the urine.

May cause fatal hepatotoxicity; very rare

110
Q

quinupristin–dalfopristin (Synercid)

A

30:70 combination; works synergistically

Used for bacteremia and infections caused by

VRE and for treatment of complicated skin and skin structure infections caused by S. pyogenes and S. aureus, including MRSA

May cause arthralgias or myalgias

Drug interactions are limited; most severe cyclosporine

Injectable form only

111
Q

vancomycin hydrochoride (Vancocin)

A

Treatment of choice for MRSA and other gram-positive infections

Oral vancomycin is indicated for the treatment of antibiotic-induced colitis (C. difficile) and for the treatment of staphylococcal enterocolitis.

Must monitor blood levels to ensure therapeutic levels and prevent toxicity

May cause ototoxicity and nephrotoxicity

112
Q

vancomycin hydrochoride (Vancocin)

A

Red man syndrome may occur.

Flushing or itching of head, neck, face, upper trunk

Additive neuromuscular blocking effects in patients receiving neuromuscular blockers

Should be infused over 60 minutes

Rapid infusions may cause hypotension.

113
Q

Colistimethate sodium (Coly-Mycin)

A

Polypeptide antibiotic that penetrates and disrupts the bacterial membrane of susceptible strains of gram-negative bacterial

Indicated for Klebsiella pneumoniae carbapenemase–producing organisms

Serious adverse effects

IV, intramuscular, inhalation administration

114
Q

Nursing Implications

A

Before beginning therapy, assess drug allergies; hepatic, kidney, and cardiac function; and other laboratory study results.

Be sure to obtain a thorough patient health history, including immune status.

Assess for conditions that may be contraindications to antibiotic use or that may indicate cautious use.

Assess for potential drug interactions.

It is essential to obtain cultures from appropriate sites before beginning antibiotic therapy.

Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early even if they feel better.

Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge

For safety reasons, check the name of the medication carefully because there are many drugs that sound alike or have similar spellings.

Each class of antibiotics has specific adverse effects and drug interactions that must be carefully assessed and monitored.

Monitor therapeutic effects.

Improvement of signs and symptoms of infection

Return to normal vital signs

Negative culture and sensitivity tests

Disappearance of fever, lethargy, drainage, and redness

Observe for and monitor adverse reactions.

STUDY CARDS (17 decks)

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