Antibiotics Flashcards
What does bacteriostatic mean?
Substances that prevent the growth or reproduction of bacteria
What does bactericidal mean?
Substances that kill bacteria
What is the goal of antibiotic therapy?
Decreasing the population of the invading bacteria to a point where the human immune system can effectively deal with the invader
How is an antibiotic treatment selected?
- 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.
What is an anaerobic bacteria?
An organism that doesn’t need oxygen to survive. (Ex. gangrene)
What is an aerobic bacteria?
A bacteria that needs oxygen to survive.
What does gram-positive mean?
The cell wall of the bacteria retains a stain or resists decolorization with alcohol. (remains purple stained)
What does gram-negative mean?
The cell wall of the bacteria loses a stain or is decolorized by alcohol. (pink stained)
When do you call a provider after looking at a sensitivity report?
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.
Considerations for Antibiotics
In Children
- 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)
Considerations for Antibiotics
In Adults
- 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
Considerations for Antibiotics
In Older Adults
- 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
Aminoglycosides
Mechanism of Action
& Indications
Bactericidal
Often serious bacterial infections
Aminoglycosides
Drug Names
Gentamicin
“-mycin”
Neomycin
Streptomycin
Tobramycin
Aminoglycosides
Contraindications
Absolute:
* Allergy
Relative:
* Renal and hepatic disease
* Hearing loss
* Myasthenia gravis
* Parkinsonism
* Pregnancy & Lactation
Aminoglycosides
Adverse Effects
👂CNS: including ototoxicity
🩸Bone marrow depression
🫘Nephrotoxicity
Aminoglycosides
Drug Interactions
- Penicillins, cephalosporins (synergistic effect = stronger effect for both)
- Loop Diuretics (increased risk for ototoxicity)
- Parenteral penicillin (cancels out aminoglycoside)
Aminoglycosides
Assessment
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
Aminoglycosides
Nursing Conclusions/Diagnoses
- 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
Aminoglycosides
Implementation
- 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
Carbapenems
Drug Names
“-penem”
Doripenem
Ertapenem
Imipenem-cilastin-relebactam
Meropenem
Meopenem-vaborbactam
Carbapenems
Mechanism of Action and Indications
Bactericidal
IV and IM
Serious Bacterial Infections
Broad Spectrum
Carbapenems
Contraindications
Absolute:
* Allergy
Relative:
* Allergy to beta lactams
* Kidney Disease
* Pregnancy or lactation
Carbapenems
Drug Interactions
- Other drugs (seizures can occure)
Carbapenems
Adverse Effects
🤢 Toxic GI effects 💩
* Pseudomembranous colitis
* Clostridium difficile diarrhea
* Nausea and vomiting
🦹 Superinfections
🧠 CNS: headache, dizziness, altered mental state
Carbapenems
Assessment
History:
* Allergy, renal disease, pregnancy or lactation
Physical:
* CNS: Orientation/Level of Consciousness
* GI
* Vital Signs
Labs:
* C&S
* Renal Function
* WBC
Carbapenems
Nursing Conclusions/Diagnoses
- Impaired Comfort (r/t GI or CNS effects)
- Superinfection risk (r/t loss of normal flora)
- Knowledge Deficit
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
Cephalosporins
Mechanism of Action & Indications
Bactericidal & Bacteriostatic
Bacterial Infections
Cephalosporins
Drug Names
“cef-“” or “ceph-“
1️⃣ cephalexin
2️⃣ cefactor, cefoxitin, cefuroxime
3️⃣ cefdinir, cefotaxime, cefpodoxime, ceftriaxone
4️⃣ ceftolozane-tazobactam
5️⃣ ceftaroline
Cephalosporins
Contraindications
Absolute:
* Allergy
Relative:
* Allergies to penicillin
* Renal Impairment
Cephalosporins
Drug Interactions
- Aminoglycosides (inc. risk of nephrotoxicity)
- Warfarin (inc. risk of bleeding)
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
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
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
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
Fluoroquinolones
Mechanism of Action & Indications
Bacteriostatic
Bacterial Infections
Broad Spectrum
Fluoroquinolones
Drug Names
“-floxacin”
* Ciprofloxacin
* Levofloxacin
* Moxifloxacin
* Ofloxacin
Fluoroquinolones
Contraindications
Absolute:
* Allergy
Relative:
* Renal dysfunction
* Liver impairment
* Myasthenia gravis
* Seizure disorder
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)
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
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
Fluoroquinolones
Nursing Conclusions/Diagnoses
- Impaired Comfort (r/t adv. effects)
- Fluid Deficit (r/t GI effects)
- Malnutrition (r/t GI effects)
- Knowledge Deficit
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
Penicillins and Penicillinase-Resistant Antibiotics
Mechanism of Action & Indications
Bactericidal
Broad Spectrum
Bacterial Infections
Penicillins and Penicillinase-Resistant Antibiotics
Drug Names
“-icillin”
Penicillin G benzathine
Penicillin G potassium
Penicillin G procaine
Penicillin V
Amoxicillin
Ampicillin
Penicillins and Penicillinase-Resistant Antibiotics
Contraindications
Absolute:
* Allergy
Relative:
* Allergy to cephalosporins
* Renal disease
Caution:
* Pregnancy & lactation
Penicillins and Penicillinase-Resistant Antibiotics
Adverse Effects
🤢 GI: N/V, stomatitis, diarrhea
🦹 Superinfections
💉 Irritation/infection at injection site
Penicillins and Penicillinase-Resistant Antibiotics
Drug Interactions
- Parenteral aminoglycosides
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
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
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)
Sulfonamides
Mechanism of Action & Indications
Bacteriostatic: inhibits folic acid synthesis
Bacterial Infections
Sulfonamides
Drug Names
“sulfa-“
sulfadiazine
sulfaalazine
trimethoprim-sulfamethoxazole
Sulfonamides
Contraindications
Absolute:
* Allergy
Relative:
* Allergy to thiazide diuretics
* Pregnancy (possibly teratogenic)
Caution:
* Renal disease/kidney stones
Sulfonamides
Drug Interactions
- Sulfonylureas (antidiabetics): glyburide, glipizide (increased risk of hypoglycemia)
- Cyclosporine (inc. risk of nephrotoxicity)
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
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
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
Tetracyclines
Mechanism of Action & Indications
Bacteriostatic
Substitute for when penicillin is contraindicated
Bacterial infections
Broad spectrum
Tetracyclines
Drug Names
“-cycline”
tetracycline
doxycycline
minocycline
Tetracyclines
Contraindications
Absolute:
* Allergy
Relative:
* Pregnancy or lactation
* Hepatic impairment
Caution:
* Children under 8 years old
Tetracyclines
Drug Interactions
Digoxin (inc. risk of digoxin toxicity)
Food: Take on an empty stomach
Tetracyclines
Adverse Effects
🤢 GI effects
🟡 Hepatotoxicity
😎 Photosensitivity
🦴 Damage to teeth & bones
🦹 Superinfections
Tetracyclines
Assessment
History:
* Allergy, renal or hepatic disease, pregnancy or lactation
Physical:
* Skin
* Skeletal
* Abdomen
Labs:
* C&S
* Renal and Hepatic function tests
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
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
Lincosamides
For use with serious infections
* Clindamycin
* Lincomycin
Lipoglycopeptides
Televancin (IV)
Dalbavancin (IV)
Oritavancin (IV)
Vancomycin (IV and oral) - treats C.diff
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
💉 Vancomycin = Very irritating to the vein
* Make sure IV is patent
* Monitor IV site frequently during infusion
Macrolides
Erythromycin
Azithromycin
Clarithromycin
Fidaxomicin (used to treat C. diff) - not absorbed systemically
Oxazolidinones
Tedizolid
Linezolid
Adverse effect: Hypertension
Monobactam
Aztreonam
IV/IM only
Antimycobacterials/
Antituberculosis Drugs
Mechanism of Action & Indications
Bactericidal
Treats TB - always used in combination with another drug
Antimycobacterials/
Antituberculosis Drugs
Drug Names
RIPE
Rifampin
Isoniazid (INH)
Pyrazinamide
Ethambutol
All 1st line treatments
Antimycobacterials/
Antituberculosis Drugs
Contraindications
Absolute:
* Allergy
Relative:
* Renal or hepatic failure
* Pregnancy or lactation
Antimycobacterials/
Antituberculosis Drugs
Drug Interactions
Do not use Rifampin and Isoniazid together without CLOSE monitoring
(increases risk for liver toxicity)
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
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
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
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
