Antibiotics Flashcards
1
Q
What does bacteriostatic mean?
A
Substances that prevent the growth or reproduction of bacteria
2
Q
What does bactericidal mean?
A
Substances that kill bacteria
3
Q
What is the goal of antibiotic therapy?
A
Decreasing the population of the invading bacteria to a point where the human immune system can effectively deal with the invader
4
Q
How is an antibiotic treatment selected?
A
- Culture and Sensitivity report must be done BEFORE treating with antibiotics
- Based on the culture & sensitivity report an antibiotic is chosen that has known to be effective at treating the organism.
5
Q
What is an anaerobic bacteria?
A
An organism that doesn’t need oxygen to survive. (Ex. gangrene)
6
Q
What is an aerobic bacteria?
A
A bacteria that needs oxygen to survive.
7
Q
What does gram-positive mean?
A
The cell wall of the bacteria retains a stain or resists decolorization with alcohol. (remains purple stained)
8
Q
What does gram-negative mean?
A
The cell wall of the bacteria loses a stain or is decolorized by alcohol. (pink stained)
9
Q
When do you call a provider after looking at a sensitivity report?
A
If the antibiotic the patient is on comes up as I (Intermediate) or R (Resistant) on the sensitivity report and the patient is not improving.
10
Q
Considerations for Antibiotics
In Children
A
- More susceptible to adverse effects (more GI and CNS effects)
- More susceptible to super infections (especially oral candidiasis)
- Some can cause harm to cartilage, teeth, and bones
- Double check doses
- Teach parents to give full dose of antibiotics, how to properly store, and when antibiotics are needed (only for bacterial infections)
11
Q
Considerations for Antibiotics
In Adults
A
- Only use as needed
- Take entire course
- Do not take antibiotics that are not prescribed to you
- Do not save antibiotics for future use
- Caution in pregnancy and lactation
- Drug interactions: Oral contraceptives
12
Q
Considerations for Antibiotics
In Older Adults
A
- Signs and symptoms of infection are different in older adults (may not have a fever)
- Same considerations as adults
- More susceptible to adverse effects
- Renal and hepatic impairment - start low and go slow
13
Q
Aminoglycosides
Mechanism of Action
& Indications
A
Bactericidal
Often serious bacterial infections
14
Q
Aminoglycosides
Drug Names
A
Gentamicin
“-mycin”
Neomycin
Streptomycin
Tobramycin
15
Q
Aminoglycosides
Contraindications
A
Absolute:
* Allergy
Relative:
* Renal and hepatic disease
* Hearing loss
* Myasthenia gravis
* Parkinsonism
* Pregnancy & Lactation
16
Q
Aminoglycosides
Adverse Effects
A
👂CNS: including ototoxicity
🩸Bone marrow depression
🫘Nephrotoxicity
17
Q
Aminoglycosides
Drug Interactions
A
- Penicillins, cephalosporins (synergistic effect = stronger effect for both)
- Loop Diuretics (increased risk for ototoxicity)
- Parenteral penicillin (cancels out aminoglycoside)
18
Q
Aminoglycosides
Assessment
A
History:
* Allergy, pregnancy, lactation, renal or hepatic disease, hearing loss, myasthenia gravis, parkinsonism
Physical:
* CNS: Orientation, LOC
* Auditory testing
* Vital Signs
Labs:
* CBC (because of bone marrow depression)
* C&S
* Renal Function
* Liver Function
19
Q
Aminoglycosides
Nursing Conclusions/Diagnoses
A
- Impaired comfort (r/t adverse effects)
- Hearing impairment (r/t ototoxicity)
- Infection risk (r/t Bone Marrow depression)
- Fluid overload risk (r/t nephrotoxicity)
- Knowledge Deficit
20
Q
Aminoglycosides
Implementation
A
- Check culture and sensitivity reports
- Ensure patient receives FULL dose of antibiotics
- Monitor infection
- Monitor for nephrotoxicity, neurotoxicity, and bone marrow suppression
- Safety measures for CNS effects (fall risk, reorientation)
- Adequate fluids
- Report any hearing changes
21
Q
Carbapenems
Drug Names
A
“-penem”
Doripenem
Ertapenem
Imipenem-cilastin-relebactam
Meropenem
Meopenem-vaborbactam
22
Q
Carbapenems
Mechanism of Action and Indications
A
Bactericidal
IV and IM
Serious Bacterial Infections
Broad Spectrum
23
Q
Carbapenems
Contraindications
A
Absolute:
* Allergy
Relative:
* Allergy to beta lactams
* Kidney Disease
* Pregnancy or lactation
24
Q
Carbapenems
Drug Interactions
A
- Other drugs (seizures can occure)
25
**Carbapenems**
Adverse Effects
🤢 **Toxic GI effects** 💩
* Pseudomembranous colitis
* Clostridium *difficile* diarrhea
* Nausea and vomiting
🦹 **Superinfections**
🧠 **CNS:** headache, dizziness, altered mental state
26
**Carbapenems**
Assessment
**History:**
* Allergy, renal disease, pregnancy or lactation
**Physical:**
* CNS: Orientation/Level of Consciousness
* GI
* Vital Signs
**Labs:**
* C&S
* Renal Function
* WBC
27
**Carbapenems**
Nursing Conclusions/Diagnoses
* Impaired Comfort *(r/t GI or CNS effects)*
* Superinfection risk *(r/t loss of normal flora)*
* Knowledge Deficit
28
**Carbapenems**
Implementation
* Check culture & sensitivity reports
* Ensure pt. takes full course of treatment
* Monitor infection site/presenting s&s
* **Monitor for signs of pseudomembranous colitis, severe diarrhea, or superinfections**
* Adequate hydration
* Small, frequent meals for GI symptoms
* Given IV or IM
29
**Cephalosporins**
Mechanism of Action & Indications
**Bactericidal & Bacteriostatic**
Bacterial Infections
30
**Cephalosporins**
Drug Names
**"cef-"" or "ceph-"**
1️⃣ **ceph**alexin
2️⃣ **cef**actor, **cef**oxitin, **cef**uroxime
3️⃣ **cef**dinir, **cef**otaxime, **cef**podoxime, **cef**triaxone
4️⃣ **cef**tolozane-tazobactam
5️⃣ **cef**taroline
31
**Cephalosporins**
Contraindications
**Absolute:**
* Allergy
**Relative:**
* Allergies to **penicillin**
* **Renal** Impairment
32
**Cephalosporins**
Drug Interactions
* **Aminoglycosides** *(inc. risk of nephrotoxicity)*
* **Warfarin** *(inc. risk of bleeding)*
33
**Cephalosporins**
Adverse Effects
🤢**Toxic GI effects**💩
* Psuedomembranous colitis
* C. *diff*
* N/V/D/flatulence
* Abdominal pain
🦹 **Superinfections**
🫘 **Nephrotoxicity**
🧠 **CNS**: Headache, dizziness, lethargy, numbness & tingling
💉 **Injection site inflammation, irritation, and infection**
34
**Cephalosporins**
Assessment
**History:**
* Allergy, allergy to **pencillins**, **renal** disease, pregnancy or lactation
**Physical:**
* Abdominal
* CNS
* Skin (injection site)
* Vitals
**Labs:**
* C&S
* Renal function tests
* WBC
35
**Cephalosporins**
Nursing Conclusions/Diagnoses
* Impaired comfort *(r/t adv. effects)*
* Infection risk *(r/t repeated injections)*
* Dehydration *(r/t GI effects)*
* Malnutrition risk *(r/t GI effects)*
* Knowledge deficit
36
**Cephalosporins**
Implementation/Patient Teaching
* Check culture & sensitivity reports
* Monitor **renal** function during therapy
* Ensure full course is taken
* Monitor infection and injection site
* Small frequent meals, frequent mouth care, ice chips, or sugarless candy/lozenges
* Adequate fluids
* Monitor for signs of **superinfections**
37
**Fluoroquinolones**
Mechanism of Action & Indications
**Bacteriostatic**
Bacterial Infections
Broad Spectrum
38
**Fluoroquinolones**
Drug Names
**"-floxacin"**
* Cipro**floxacin**
* Levo**floxacin**
* Moxi**floxacin**
* O**floxacin**
39
**Fluoroquinolones**
Contraindications
**Absolute:**
* Allergy
**Relative:**
* **Renal** dysfunction
* **Liver** impairment
* **Myasthenia gravis**
* **Seizure** disorder
40
**Fluoroquinolones**
Drug Interactions
* Iron salts, sucralfate, mineral supplements, antacids *(decreases effect of fluoroquinolones)*
* Other drugs that increase the **QT interval** *(inc. risk of cardiac issues)*
* **Theophylline** *(inc. risk of theophylline toxicity)*
* **NSAIDs** *(can inc. CNS effects)*
41
**Fluoroquinolones**
Adverse Effects
🧠 **CNS:** headache, dizziness, insomnia, depression, hallucinations
🩸 **Bone Marrow Depression**
🤢 **GI:** N/V/D, dry mouth, C. *diff*
**Liver toxicity**
💓 **CV:** Prolonged **QT interval**
⬛ **Black Box Warning:** Risk for tendinitis and **tendon rupture**, CNS effects including **hallucinations**
42
**Fluoroquinolones**
Assessment
**History:**
* Allergy, myasthenia gravis, seizure disorder, renal or hepatic disease, pregnancy or lactation
**Physical:**
* Abdominal
* CNS
* Skin
* Cardiac **QT interval**
* Vitals
**Labs:**
* C&S
* **Renal & liver** function tests
* CBC
43
**Fluoroquinolones**
Nursing Conclusions/Diagnoses
* Impaired Comfort *(r/t adv. effects)*
* Fluid Deficit *(r/t GI effects)*
* Malnutrition *(r/t GI effects)*
* Knowledge Deficit
44
**Fluoroquinolones**
Implementation/Patient Teaching
* Check culture & sensitivity reports
* Monitor **renal and liver** function tests
* Ensure pt. takes full dose of treatment
* Monitor site of infection/presenting s/s
* Small, frequent meals, mouth care, ice chips, sugarless candy for GI issues
* Adequate fluids
* Teach pt. about **Black Box warning**
* Notify provider of any CNS effects
* Wear sunscreen/avoid excessive sun exposure
45
**Penicillins and Penicillinase-Resistant Antibiotics**
Mechanism of Action & Indications
**Bactericidal**
Broad Spectrum
Bacterial Infections
46
**Penicillins and Penicillinase-Resistant Antibiotics**
Drug Names
**"-icillin"**
Pen**icillin** G benzathine
Pen**icillin** G potassium
Pen**icillin** G procaine
Pen**icillin** V
Amox**icillin**
Amp**icillin**
47
**Penicillins and Penicillinase-Resistant Antibiotics**
Contraindications
**Absolute:**
* Allergy
**Relative:**
* Allergy to **cephalosporins**
* **Renal** disease
**Caution:**
* Pregnancy & lactation
48
**Penicillins and Penicillinase-Resistant Antibiotics**
Adverse Effects
🤢 **GI:** N/V, stomatitis, diarrhea
🦹 **Superinfections**
💉 **Irritation/infection at injection site**
49
**Penicillins and Penicillinase-Resistant Antibiotics**
Drug Interactions
* **Parenteral aminoglycosides**
50
**Penicillins and Penicillinase-Resistant Antibiotics**
Assessment
**History:**
* Allergy, **renal** disease, pregnancy or lactation, allergy to **cephalosporins**
**Physical:**
* Skin *(injection site)*
* Abdominal
**Labs:**
* C&S
* Renal function test
* WBC
51
**Penicillins and Penicillinase-Resistant Antibiotics**
Nursing Conclusions/Diagnoses
* Impaired comfort *(r/t adverse effects)*
* Malnutrition *(r/t GI effects)*
* Dehydration *(r/t GI effects)*
* Knowledge Deficit
52
**Penicillins and Penicillinase-Resistant Antibiotics**
Implementation/Patient Teaching
* Check culture & sensitivity reports
* Ensure pt. takes full course of treatment
* Monitor **renal** function
* Take oral routes on an **EMPTY stomach**
* Monitor site of infection/presenting s/s
* Small, frequent meals, mouth care, ice chips, or sugarless candy for GI effects
* Adequate fluids
* Monitor for any superinfection
* Monitor injection sites
* Teach proper storage *(possible refrigeration)*
53
**Sulfonamides**
Mechanism of Action & Indications
**Bacteriostatic: inhibits folic acid synthesis**
Bacterial Infections
54
**Sulfonamides**
Drug Names
**"sulfa-"**
**sulfa**diazine
**sulfa**alazine
trimethoprim-**sulfa**methoxazole
55
**Sulfonamides**
Contraindications
**Absolute:**
* Allergy
**Relative:**
* Allergy to **thiazide** diuretics
* Pregnancy *(possibly teratogenic)*
**Caution:**
* **Renal disease/kidney stones**
56
**Sulfonamides**
Drug Interactions
* **Sulfonylureas** (antidiabetics): glyburide, glipizide *(increased risk of hypoglycemia)*
* **Cyclosporine** *(inc. risk of nephrotoxicity)*
57
**Sulfonamides**
Adverse Effects
🤢 **GI:** N/V/D, abdominal pain, stomatitis
🫘 **Kidney:** hematuria, crystalluria, proteinuria, hyperkalemia
🧠 **CNS:** headache, dizziness
🔴 **Skin:** **Stevens-Johnson syndrom** *(medical emergency - needs hospitalization)*, photosensitivity
🩸**Bone Marrow Depression**
58
**Sulfonamides**
Assessment
**History:**
* Allergy, allergy to **thiazide** diuretics, **renal** disease, pregnancy or lactation
**Physical:**
* Skin
* CNS
* Abdominal
* Urinary
**Labs:**
* C&S
* **Renal** function tests
* **CBC**
* **Glucose**
59
**Sulfonamides**
Implementation/Patient Teaching
* Check culture & sensitivity reports
* Ensure pt. receives full course of treatment
* Small, frequent meals, mouth care, ice chips, sugarless candy for GI effects
* Monitor infection
* Adequate fluid intake
* Monitor **CBC**, **renal function**, and **urinalysis** results periodically during therapy
* Monitor **glucose** if patient is on a sulfonylureas
60
**Tetracyclines**
Mechanism of Action & Indications
**Bacteriostatic**
Substitute for when penicillin is contraindicated
Bacterial infections
Broad spectrum
61
**Tetracyclines**
Drug Names
**"-cycline"**
tetra**cycline**
doxy**cycline**
mino**cycline**
62
**Tetracyclines**
Contraindications
**Absolute:**
* Allergy
**Relative:**
* Pregnancy or lactation
* **Hepatic** impairment
**Caution:**
* **Children under 8 years old**
63
**Tetracyclines**
Drug Interactions
**Digoxin** *(inc. risk of digoxin toxicity)*
Food: Take on an **empty stomach**
64
**Tetracyclines**
Adverse Effects
🤢 **GI effects**
🟡 **Hepatotoxicity**
😎 **Photosensitivity**
🦴 **Damage to teeth & bones**
🦹 **Superinfections**
65
**Tetracyclines**
Assessment
**History:**
* Allergy, renal or hepatic disease, pregnancy or lactation
**Physical:**
* Skin
* Skeletal
* Abdomen
**Labs:**
* C&S
* Renal and Hepatic function tests
66
**Tetracyclines**
Nursing Conclusions/Diagnoses
* Impaired comfort *(r/t adverse effects)*
* Malnutrition *(r/t GI effects)*
* Altered skin integrity risk *(r/t rash, photosensitivity)*
* Knowledge Deficit
67
**Tetracyclines**
Implementation/Patient Teaching
* Check culture & sensitivity report
* Ensure pt. takes full course of treatment
* Monitor renal and **liver** function tests
* Take on an **empty stomach** with a full **8-oz glass of water**
* Small, frequent meals, mouth care, ice chips, or sugarless candy for GI effects
* Encourage patient to apply **sunscreen and wear protective clothing**
* Monitor for signs of superinfection
68
**Lincosamides**
For use with serious infections
* C**lin**damycin
* **Lin**comycin
69
**Lipoglycopeptides**
Tele**van**cin (IV)
Dalba**van**cin (IV)
Orita**van**cin (IV)
**Van**comycin (IV and oral) - treats C.*diff*
70
**Vancomycin**
Adverse Effects
🔴 **Red Man syndrome**: *Caused by Rapid infusion or 1st infusion*
Sudden hypotension, flushing, pruritis, red rash on face
*Treated by slowing down infusion*
💉 **V**ancomycin = **V**ery irritating to the **v**ein
* Make sure IV is patent
* Monitor IV site frequently during infusion
71
**Macrolides**
Ery**thromycin**
Azi**thromycin**
Clari**thromycin**
Fidaxomicin *(used to treat C. diff)* - not absorbed systemically
72
**Oxazolidinones**
Tedi**zolid**
Line**zolid**
Adverse effect: Hypertension
73
**Monobactam**
**Aztreonam**
IV/IM only
74
**Antimycobacterials/
Antituberculosis Drugs**
Mechanism of Action & Indications
**Bactericidal**
Treats TB - ***always*** used in combination with another drug
75
**Antimycobacterials/
Antituberculosis Drugs**
Drug Names
**RIPE**
**Rifampin**
**Isoniazid (INH)**
**Pyrazinamide**
**Ethambutol**
*All 1st line treatments*
76
**Antimycobacterials/
Antituberculosis Drugs**
Contraindications
**Absolute:**
* Allergy
**Relative:**
* Renal or hepatic failure
* Pregnancy or lactation
77
**Antimycobacterials/
Antituberculosis Drugs**
Drug Interactions
Do not use Rifampin and Isoniazid together without CLOSE monitoring
*(increases risk for liver toxicity)*
78
**Antimycobacterials/
Antituberculosis Drugs**
Adverse Effects
**CNS** effects
**GI** irritation
Interferes with **hormonal birth control**
**Rifampin**:
* REDfampin: discolors bodily fluids a red color *(urine, saliva, tears, sweat, etc.)*
* Liver toxicity
**Isoniazid**:
* Interferes with absorption of Vitamin B6, leads to neuropathy
* Liver toxicity
**Ethambutol:**
* Baseline and periodic eye exams needed
* Report blurred vision or color changes
79
**Antimycobacterials/
Antituberculosis Drugs**
Assessment
**History:**
* Allergy, renal or hepatic disease, pregnancy or lactation
**Physical:**
* Skin
* CNS
* GI
* Respiratory *(to check TB infection)*
**Labs:**
* C&S
* Renal and hepatic function tests
80
**Antimycobacterials/
Antituberculosis Drugs**
Nursing Conclusions/Diagnoses
* Malnutrition *(r/t GI effects)*
* Altered sensory perception *(r/t CNS effects)*
* Impaired comfort *(r/t GI effects)*
* Knowledge Deficit
81
**Antimycobacterials/
Antituberculosis Drugs**
Implementation/Patient Teaching
* Check culture & sensitivity reports
* Monitor renal and liver function tests results periodically during therapy
* Ensure pt. receives FULL course of treatment: **6 months to 2 years**
* Small frequent meals, mouth care for GI effects
* Adequate fluid
* **Barrier contraceptives**
* May need to re-educate over time due to long treatment
* Rifampin: red bodily fluids - *no need to report*
* **INH: report numbness or tingling**
* **Ethambutol: Report blurred vision**
