Antibiotics Flashcards
Antibiotics across the lifespan: CHILDREN
-kids are more sensitive to adverse effects
^monitor their hydration and nutrition when seeing diarrhea, nausea, vomiting, anorexia
-super infections, especially oral candidiasis (thrush)
-use caution as many of these meds have not established safety and efficacy for children
-some can cause harm to growing cartilage, bones, and teeth (tigecycline)
-double check doses
-patient education on when to use antibiotics (not for viral infections, administering the full course of the meds, and proper storage)
Antibiotics across the lifespan: ADULTS
-only use as needed
-do not take antibiotics that were not prescribed to you
-don’t save antibiotics for future use
-Pregnancy/lactation: only use when benefit outweighs the risk
^tetracylines can damage teeth and bones: aminoglycosides can cause hearing loss
oral contraceptives are considered drug-drug interactions
Antibiotics across the lifespan: OLDER ADULTS
they may present with different S/S of infection (many older adults don’t get fevers)
-obtaining a culture before providing medication is even more important
-more susceptible to adverse effects: monitor for hydration and nutrition if they’re having adverse effects of nausea, vomiting, anorexia, or diarrhea.
-only use as needed
-do not take antibiotics that were not prescribed to you
-don’t save antibiotics for future use
Renal and hepatic impairment: start low go slow
Drug class: Aminoglycosides
What are the suffixes or drug names in this class?
-“-mycin”
-Neomycin
-Streptomycin
-Tobramycin
Drug class: Aminoglycosides
What are the actions?
Bactericidal (kill of the bacteria)
Drug class: Aminoglycosides
What are the indications?
Serious bacteria infections
Drug class: Aminoglycosides
What are the contraindications?
-Abosulue: anaphylactic allergy
-Relative:
renal or hepatic disease (r/t adverse of effect of being nephrotoxic)
hearing loss (this drug can cause ototoxicity)
myasthenia gravis or Parkinsonism(these conditions can be worsened with the use of amino glycosides)
pregnancy/lactation (benefits need to outweigh the risks)
Drug class: Aminoglycosides
What are the adverse effects?
CNS: ototoxicity (never irreversible)
Nephrotoxicity (usually reversible)
Bone marrow depression
Drug class: Aminoglycosides
What are the drug-drug interactions?
-Penicillins, cephalosporins
-Loop diuretics (has their own risk of ototoxicity)
-Parenteral penicillin
Nursing process of aminoglycosides
Assessment:
-Hx of allergy, renal or hepatic disease, preexisting hearing loss, myasthenia gravis or Parkinsonism
Pregnancy or lactation
Phys:
CNS: orientation, level of consciousness
Auditory testing
Vital signs
Labs: C&S, renal function, hepatitis function, CBC
Nursing process of aminoglycosides
Nursing diagnoses
-impaired comfort r/t GI or CNS effects
-hearing impairment r/t to CNS effect of ototoxicity
-infection risk r/t bone marrow suppression
-fluid overload risk r/t nephrotoxicity
Nursing process of aminoglycosides
Implementation:
-check culture and sensitivity reports to ensure patient is on correct antibiotic
-ensure patient receives full course of aminoglycoside as prescribed
-monitor infection site to see if signs and symptoms are improving
-monitor for nephrotoxicity, neurotoxicity, and bone marrow suppression
-safety measures due to CNS effects (fall precautions)
-adequate fluids to stay well hydrated throughout therapy
-patient teaching
Drug class: Carbapenems
What are the suffixes or drug names in this class:
“-penem”
-Doripenem
-Ertapenem
-Meropenem
-Meropenem-varbobactam
-Imipenem-cilastin-relebactam
-Imipenem-cilastin
Drug class: Carbapenems
What are the actions?
Bactericidal
Drug class: Carbapenems
What are the indications?
Serious bacterial infections
Given IV or IM
Drug class: Carbapenems
What are the contraindications?
Absolute: allergy
Relative: allergy to beta-lactams and kidney disease
Drug class: Carbapenems
What are the drug drug interactions?
Increased risk when combined with other drugs for seizures
Drug class: Carbapenems
What are the adverse effects?
-toxic GI effects leading to dehydration and electrolyte imbalances
^ nausea and vomiting
^ pseudomembranous colitis (severe form of colitis that can be caused from C.diff)
^ C.diff diarrhea
-superinfections can occur due to the imbalance of our normal flora
-CNS effects: headache, dizziness, altered mental state
Nursing process of Carbapenems
Assessment:
-Hx of allergy, renal disease, pregnancy/lactation
-Phys: CNS orientation, level of consciousness. GI assessment and vital signs
Labs: C&S, renal function, WBC
Nursing process of Carbapenems
Nursing diagnoses:
-impaired comfort r/t GI or CNS effects
-superinfection risk r/t loss of normal flora
Nursing process of Carbapenems
Implementation:
-check culture and sensitivity report
-ensure patient receives full course as prescribed
-monitor infection site and presenting signs and symptoms
-monitor for signs of pseudomembranous colitis severe diarrhea, or superinfections
-safety measures due to CNS effects
-provide small frequent meals for GI upset as tolerated
-ensure adequate hydration
-patient teaching
Drug class: Cephalosporins
What are the prefix and drug names in this class?
-common medications “-cef” or “-ceph”
1st gen: cephalexin
2nd gen: cefaclor, cefoxitin, cefroxime
3rd gen: cefdinir, cefotaxime, cefpodoxime, ceftriaxone
4th gen: ceftolozane-tazobactam
5th gen: ceftaroline
Drug class: Cephalosporins
What are the actions?
Bactericidal and bacteriostatic
Drug class: Cephalosporins
What are the indications?
Bacterial infections
Drug class: Cephalosporins
What are the contraindications?
-Absolute: allergy
-Relative:
allergies to penicillin
renal impairment
Drug class: Cephalosporins
What are the drug-drug interactions?
-Aminoglycosides (increased risk for nephrotoxicity)
-Warfarin (increased risk for bleeding)
Drug class: Cephalosporins
What are the adverse effects?
-GI: nausea, vomiting, diarrhea, flatulence, abdominal pain, pseudomembranous colitis, and C.diff
-Superinfections
-Nephrotoxicity
-CNS: headache, dizziness, lethargy, parenthesia
-Injection site inflammation, irritation, and infection
Nursing process of Cephalosporins
Assessment:
-Hx of allergy, allergy to penicillin, renal disease pregnancy/lactation
Phys: abdominal, CNS, skin (injection site), vital signs
Labs: C&S, renal function, WBC
Nursing process of Cephalosporins
Nursing diagnoses:
-impaired comfort r/t GI and CNS effects
-infection risk r/t repeated injections
-dehydration and malnutrition r/t GI effects
Nursing process of Cephalosporins
Implementation:
-check the C&S report
-monitor renal function during therapy
-ensure full course is taken as prescribed
-monitor infeciton site
-monitor injection site
-small frequent meal, frequent mouth care, ice chips or sugarless lozenges/candy
-monitor for any signs of superinfection
Drug class: Fluoroquinolones
What are the suffixes or drug names in this class?
“-floxacin”
-Ciprofloxacin
-Levofloxacin
-Moxifloxacin
-Ofloxacin
Drug class: Fluoroquinolones
What are the actions?
-Bacteriostatic (prevent growth and reproduction of the bacteria)
-Broad spectrum
Drug class: Fluoroquinolones
What are the indications?
For bacterial infections
Drug class: Fluoroquinolones
What are the contraindications?
-Absolute: anaphylactic allergy
-Relative:
Renal dysfunction
Liver impairment
Myasthenia gravis
Seizure disorder
Drug class: Fluoroquinolones
What are the drug-drug interactions?
-Iron salts, sucralfate, mineral supplements, antacids (decrease the effects of fluoroquinolones)
^ separate administration by at least 4 hours
-Other drugs that increase the QT interval (fatal cardiac arrhythmia s can occur)
-Theophylline (can be toxic)
-NSAIDs (can increase CNS effects such as hallucinations)
BLACK BOX WARNING: risk for tendinitis and tendon rupture, CNS effects including hallucinations
Drug class: Fluoroquinolones
What are the Adverse effects?
CNS: headache, dizziness, insomnia, depression, hallucinations
Bone marrow depression
Photosensitivity
GI: nausea, vomiting, diarrhea, dry mouth, C.diff, liver toxicity
CV: prolonged QT interval
Nursing process of Fluoroquinolones
Assessment:
Hx of allergy, myasthenia gravis, seizure disorders, renal or hepatic disease, pregnancy/lactation
Phys: abdominal, CNS, skin, cardiac, vital signs
Labs: C&S, renal function, CBC
Nursing process of Fluoroquinolones
Nursing diagnoses
-impaired comfort r/t CNS and GI effects
-dehydration and malnutrition r/t GI effects
Nursing process of Fluoroquinolones
Implementation:
-Check culture and sensitivity reports to make sure patient is on the right drug
-Monitor renal function tests
-Ensure patient receives the full course as prescribed
-Monitor the site of infection
-Small frequent meals as tolerated, mouth care, ice chips, surgarless candy
-Adequate fluids
-Patient teaching: instruct them to advise the provider immediately, if any adverse effects occur r/t black box warning
Drug class: Penicillin and penicillinase-resistant antibiotics
What are the suffixes or drug names in this class?
-“icillin”
-Penicillin G benzathine
-Penicillin G potassium
-Penicillin G procaine
-Penicillin V
-Amoxicillin
-Ampicillin
Drug class: Penicillin and penicillinase-resistant antibiotics
What are the actions?
-Bacterialcidal
-Broad spectrum
Drug class: Penicillin and penicillinase-resistant antibiotics
What are the indications?
Bacterial infections
Drug class: Penicillin and penicillinase-resistant antibiotics
What are the contraindications?
Absolute: allergy
Relative: allergy to cephalosporins & renal disease
Caution: pregnancy/lactation
Drug class: Penicillin and penicillinase-resistant antibiotics
What are the adverse effects?
Most significant: GI tract (nausea, vomiting, diarrhea, stomatitis)
-irritation or infection at injection site
-superinfections
Drug class: Penicillin and penicillinase-resistant antibiotics
What are the drug-drug interactions?
Parenteral aminoglycosides + parenteral penicillin = deactivation of the aminoglycoside
Nursing process of Penicillin and penicillinase-resistant antibiotics
Assessment:
Hx of allergy, renal disease, pregnancy/lactation
Phys: skin check (rashes, lesions, irritations), abdominal assessment
Labs: C&S, renal function, WBC
Nursing process of Penicillin and penicillinase-resistant antibiotics
Nursing conclusions:
-Impaired comfort r/t GI effects
-Malnutrition and dehydration r/t GI effects
Nursing process of Penicillin and penicillinase-resistant antibiotics
Implementation:
-Check culture & sensitivity reports
-Monitor renal function periodically during therapy
-Ensure patient receives full course as prescribed
-Take oral routes on an empty stomach
-Monitor the site of infection
-Small, frequent meals, frequent mouth care ice chips, sugarless candy
-Provide adequate fluids
-Monitor the patient for any signs of superinfections
-Monitor and care for injection sites
Drug class: Sulfonamides
What are the suffixes or drugs in this class?
“-sulfa”
-Sulfadiazine
-Sulfasalazine
-Trimethoprim-sulfamethoxazole
Drug class: Sulfonamides
What are the actions?
Bacteriostatic by inhibiting folic acid synthesis which prevents reproduction of the bacteria
Drug class: Sulfonamides
What are the indications?
Bacterial infections
Drug class: Sulfonamides
What are the contraindications?
Absolute: allergy
Relative: allergy to thiazide diuretics
pregnancy: possibly teratogenic
Caution: renal disease/kidney stones
Drug class: Sulfonamides
What are the drug-drug interactions?
-Sulfonylureas (anti diabetics) like glyburide, glipizide (increased risk for hypoglycemia)
-Cyclosporine (increased risk of nephrotoxicity)
Drug class: Sulfonamides
What are the adverse effects?
GI: nausea, vomiting, diarrhea, abdominal pain, stomatitis
Renal: hemauria, crysalluria, proteinuria, hyperkalemia
CNS: headache, dizziness
Skin: Steven’s-Johnson syndrome (medical emergency/ requires hospitalization), photosensitivity
Bone marrow depression
Nursing process of Sulfonamides
Assessment:
Hx of allergy, renal disease, pregnancy/lactation
Phys: Skin, CNS, abdominal urinary
Labs: C&S, renal function, CBC
Nursing process of Sulfonamides
Nursing diagnoses:
-impaired comfort r/t GI, CNS, and skin effects
-altered sensory perception r/t CNS effects
-malnutrition r/t GI effects
Nursing process of Sulfonamides
Implementation:
-check C&S reports
-ensure patient receives the full course as prescribed
-small frequent meals, mouth care ice chips, or sugarless candy
-adequate fluid intake
-safety precautions
-monitor CBC, renal function and urinalysis results periodically urine therapy
-monitor glucose if patient is on a sulfonylureas (anti diabetic)
Nursing process of Sulfonamides
Implementation:
-check C&S reports
-ensure patient receives the full course as prescribed
-small frequent meals, mouth care ice chips, or sugarless candy
-adequate fluid intake
-safety precautions
-monitor CBC, renal function and urinalysis results periodically urine therapy
-monitor glucose if patient is on a sulfonylureas (anti diabetic)
Drug class: Tetracyclines
What are the suffixes and drug names in this class?
“-cycline”
-Tetracycline
-Doxycycline
-Minoycline
Drug class: Tetracyclines
What are the actions?
Bacteriostatic
Drug class: Tetracyclines
What are the indications?
-bacterial infections
-substitute for when Penicillin is contraindicated
Drug class: Tetracyclines
What are the contraindications?
Absolute: allergy
Relative: pregnancy/lactation & hepatic impairment
Caution: children under 8 yrs old
Drug class: Tetracyclines
What are the drug-drug interactions?
Digoxin (increases the risk of dig toxicity)
Drug-food: administer on an empty stomach (1 hour before or 2 hours after any food or dairy products)
Drug class: Tetracyclines
What are the adverse effects?
-GI effects
-Hepatotoxicity
-Photosensitivity
-Damage to the teeth and bones (why we typically don’t give these drugs to children under 8)
-Superinfections
Nursing process of Teracylines
Assessment:
Hx of allergy, renal or hepatic disease, pregnancy/lactation
Phys: skin, skeletal, abdomen
Labs: renal and hepatic function tests. C&S
Nursing process of Teracylines
Implementation:
-check C&S reports
-monitor renal and liver function test results
-ensure that patient receives full course as prescribed
-[take on empty stomach with a full 8 oz glass of water]
-small frequent meals, mouth care, ice chips, or sugarless candy
-monitor for signs of superinfections
-encourage patient to apply sunscreen and protective clothing r/t photosensitivity
Drug class: Other antibiotics
Lincosamides
-clindamycin, lincomycin
*for serious infections because they have a high risk for pseudomembranous colitis
Drug class: Other antibiotics
Lipoglycopeptides
“Van” in the name
-Telavancin, dalbavancin, oritavancin, vancomycin
except for vancomycin, all these drugs are IV only
Oral vancomycin is one of the treatments for C.diff
ADE: risk or nephrotoxicity, prolong QT interval, and foamy urine
Drug class: Macrolides
“thromycin”
-Erythromycin, azithromycin, clarithromycin, fidaxomicin
-Fidaxomycin treats C.diff, not absorbed systemically (in ages 6mo and up)
Drug class: Other antibiotics
Oxazolidinones
“-zolid”
-Tedizolid, Linezolid
ADE: hypertension
Drug class: Other antibiotics
Monobactam
-Aztreonam
IV or IM ONLY
Drug class: Antimycobacterials/Antituberculosis drugs
What are the suffixes and drug names in this class?
-Rifampin
-Isoniazid (INH)
-Pyrazinamide
-Ethambutol
= RIPE
Drug class: Antiycobacterials/Antituberculosis drugs
What are the actions?
Bactericidal
Drug class: Antimycobacterials/Antituberculosis drugs
What are the indications?
Treatment of TB
(We always use drugs in this class in combination with each other to prevent further drug resistant strains)
Drug class: Antimycobacterials/Antituberculosis drugs
What are the contraindications?
Absolute: allergy
Relative: renal or hepatic failure
pregnancy/lactation (if we have to treat in pregnancy well use INH, rifampin, and
Drug class: Antiycobacterials/Antituberculosis drugs
What are the contraindications?
Absolute: allergy
Relative: renal or hepatic failure
pregnancy/lactation (if we have to treat in pregnancy well use INH, rifampin, and ethambutol)
Drug class: Antimycobacterials/Antituberculosis drugs
What are the drug-drug interactions?
Rifampin and isoniazid (together) can cause liver toxicity
Drug class: Antimycobacterials/Antituberculosis drugs
What are the adverse effects?
-CNS: dizziness, drowsiness, headache, hallucinations
-GI: nausea, vomiting, diarrhea, abdominal pain, anorexia
Interferes with hormonal birth control
*Rifampin: RED-fampin * discolors bodily fluids a red/orange color (risk of liver toxicity)
*Isniazid: interferes with absorption of vitamin B6 (risk of neuropathy)
Ethambutol: E= eye baseline and periodic eye exams
^ report blurred vision or color changes
Nursing process Antimycobacterials/Antituberculosis
Assessment:
Hx of allergy, renal or hepatic disease, pregnancy/lactation
Phys: examine skin for rash or lesions, CNS, GI, and respiratory status
Labs: C&S, renal and hepatic function tests
Nursing process Antimycobacterials/Antituberculosis
Nursing diagnoses:
-malnutrition r/t GI effects
-altered sensory perception (kinesthetic) r/t CNS effects
-impaired comfort r/t GI effects
Nursing process Antimycobacterials/Antituberculosis
Implementation:
-check culture & sensitivity reports, repeat culture as needed
(treatment for TB can take up to 2 years- 6 months is the lowest amount of time)
-monitor renal and liver function test result periodically during therapy
-ensure that patient receives the full course of the drug
-small frequent meals, perform frequent mouth care, and drink adequate fluids
-barrier contraceptives
