Antibiotics Flashcards
What are the two types of antibiotics?
Bacteriostatic & Bactericidal
Explain Bacteriostatic
Prevents reproduction of bacteria and fights off the bacteria already in our body.
Explain Bactericidal
kills bacteria directly.
What is the Goal of Antibiotic Therapy?
Decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invader - we still want our immune system to do its job.
How do we select the treatment for an bacterial infection?
- First we get a patient sample.
- By Identification of the causative organism.
- Based on the culture report, an antibiotic is chosen that has been known to be effective at treating the invading organism.
- In the meantime we can use a broad specter antibiotic which is an antibiotic that we know works for lot of different infections.
CULTURE MUST BE TAKEN BEFORE ADMINISTRATION OF ANTIBIOTIC! - If we take it after administering it can affect the sample.
What must be completed prior to administrating antibiotics?
Culture
What are the 4 classifications of bacteria?
Gram-positive
Gram-negative
Aerobic
Anaerobic
Explain Gram-positive bacteria.
The cell wall retains a stain or resists decolorization with alcohol.
Explain Gram-negative bacteria.
The cell wall loses a stain or is decolorized by alcohol
Explain Aerobic bacteria.
Depend on oxygen for survival.
Explain Anaerobic bacteria.
Does not depend on oxygen. An example is gangrene.
Explain the concept of bacterial resistance to antibiotics.
Bacteria adapt to their environment.
The longer an antibiotic has been in use, the greater the chance that the bacteria will develop into a resistant strain
What is penicillinase?
The bacteria has become resistance to penicillin.
What is a sensitivity report?
we use the report to determine if the antibiotics that the patient is on is going to be effective or not.
If it has an ‘R’ after its name it means that the bacteria is Resistant to this antibiotic. If it has an ‘S’ after its name it means that the bacteria is sensitive to this antibiotic and we want to keep using or switch to this antibiotic. If it has an ‘I’ after it, it means intermediate, so it means that it might work or not.
What lifespan consideration should be taken when administering antibiotics to children?
- Kids are more sensitive to adverse effects - have more GI and CNS reactions.
- Monitor hydration and nutrition esp. with GI effects.
- Super infections, especially thrush/oral candidiasis - can make eating and drinking painful.
- Many do not have proven safety and efficacy
- Some can cause harm to growing cartilage, bones, and teeth
- Double check doses
- Parent education
What lifespan consideration should be taken when administering antibiotics to adults?
- Patient education
- Only use as needed
- Take entire course
- Do not take antibiotics not prescribed to you
- Don’t save antibiotics for future use
- Pregnancy and lactation - Only if benefits outweigh risks
- Adverse effects can affect fetus and neonates
- i.e. tetracyclines can damage teeth and bones; aminoglycosides can cause hearing loss
- Drug-Drug interactions: Oral contraceptives
What lifespan consideration should be taken when administering antibiotics to older adults?
- Signs and symptoms of infections are different in the older adult - many don’t get fevers.
- Only use as needed
- Take entire course
- More susceptible to adverse effects
- Monitor hydration
- Safety precautions
- Renal and hepatic impairment
- Start low, go slow
What are the suffix(ex), drug names and potential outlier for the Aminoglycosides antibiotics?
- Gentamicin
- -mycin
- Neomycin
- Streptomycin
- Tobramycin
What is the indication for giving patients Aminoglycosides?
Serious Bacterial infections
How does Aminoglycosides work in the body?
They are Bactericidal - Go in and kill the bacteria.
What are the contraindications to giving patients Aminoglycosides?
Absolute Contraindication: Anaphylactic allergy
Relative Contraindications :
Renal (Due to adverse effect of nephrotoxicity)
Hepatic disease (can effect metabolism) ,
Hearing loss - Drugs can cause ototoxicity.
Myasthenia Gravis or Parkinsonism (can be worsened with he use of Aminoglycosides),
Pregnancy or Lactation.
What are some known adverse reactions that patients who are taking Aminoglycosides may experience?
- CNS effects due to the effect on nerves incl ototoxicity (often irreversible)
- Nephrotoxicity (usually reversible once medication is stopped)
- Bone marrow depression
Are there any known DDI’s with Aminoglycosides and if so, what are they?
- Penicillin’s & cephalosporins when used together with Aminoglycosides it can have an synergistic (increasing) effect.
- Loop diuretics due to loop diuretics also being ototoxic.
- Parenteral penicillin inactivates parenteral Aminoglycosides.
Prior to giving a patient Aminoglycosides what are some patient assessments that we should be doing?
History
* Allergy, renal or hepatic disease; preexisting
hearing loss; Myasthenia Gravis & Parkinsonism
* Pregnancy or lactation
* Physical exam
* CNS: Orientation/LOC
* Auditory testing
* Vital signs
* Labs: C&S, renal function, hepatic function, CBC- due to adverse bone marrow depression risk.
What nursing diagnoses can we anticipate prior to giving patients Aminoglycosides?
- Impaired comfort r/t CNS and GI effect
- Hearing impairment r/t CNS effect of ototoxicity.
- Infection risk r/t bone marrow suppression
- Fluid overload risk r/t nephrotoxicity
- Knowledge deficit
What implementations should we be doing when/after we’re administrating Aminoglycosides?
- Check culture and sensitivity reports to ensure patient receives a full correct course of aminoglycoside as prescribed
- Monitor infection site
- Monitor for nephrotoxicity, neurotoxicity, and bone marrow suppression
- Safety measures due to CNS effects
- Adequate fluids to stay well hydrated throughout therapy
- Provide patient teaching
What are the suffix(ex), drug names and potential outlier for the Carbapenems antibiotics?
Common medications “–penem”
* Doripenem
* Ertapenem
* Imipenem-cilastatin
* Imipenem-cilastin-relebactam
* Meropenem
* Meopenem-vaborbactam
What is the indication for giving patients Carbapenems?
Serious Bacterial infections
How are Carbapenems given?
Via IV or IM
How does Carbapenems work?
They are Bactericidal
Are Carbapenems gram positive or negative?
They are both so they are often used as a broad spectrum antibiotic.
What conditions would contraindicate the use of Carbapenems?
Absolute Contraindications
* Anaphylactic allergy
Relative Contraindications
* Allergy to other beta-lactams antibiotics : Those that have a beta-lactam ray nucleolus for example Carbapenems but so are cephalosporins and penicillin’s.
kidney disease.
Are there any known DDI’s to Carbapenems and if so, what are they?
Other drugs can cause seizures
What are some adverse reactions that we may see with patients taking Carbapenems?
- Toxic GI effects leading to dehydration and electrolyte imbalances
- Pseudomembranous colitis - severe form of colitis where something attacks and injures the mucosa of the colon and at the site a thick scab-like scab develops - 90 % of cases caused by C-diff and 10 % progress to Pseudomembranous colitis.
- Clostridium difficile diarrhea (C-diff) - can occur after taking antibiotics due to good bacteria death.
- Nausea and vomiting
- Superinfections - Normal flora disruption leads to development of superinfection. such as C-diff or thrush.
- CNS effects
Prior to giving patients Carbapenems, what are some things that we need to be assessing for?
History
* Allergy
* Renal disease
* Pregnancy or lactation
Physical
* CNS: orientation/Level of consciousness
* GI
* Vital signs
* Labs: C&S, renal function, WBC
What nursing diagnoses could we anticipate prior to giving patients Carbapenems?
- Impaired comfort r/t GI or CNS
- superinfection risk r/t loss of normal flora
- Knowledge deficit
What implementations should we be do or be prepared to do when/after administering Carbapenems to patients?
- Check culture and sensitivity reports
- 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 as tolerated
- Adequate hydration
- Provide patient teaching
What can inactivate parenteral Aminoglycosides?
Parenteral Penicillin - we would get all the risks and adverse reactions of the Aminoglycoside but none of the benefits.
What are the suffix(es), drug names, and potential outlier that we need to know for Cephalosporins?
“cef” or “ceph” in the name.
1st generation : cephalexin
2nd generation : cefaclor, cefoxitin, cefuroxime
3rd generation : cefdinir, cefotaxime, cefpodoxime, ceftriaxone
4th generation : ceftolozane-tazobactam
5th generation: ceftaroline
How does the provider choose which generation of Cephalosporins to use?
The type of bacterial infection.
What are the absolute contraindications to Cephalosporins?
Allergy
What are the relative contraindications to Cephalosporins?
Penicillin allergies due to cross sensitivity
Renal impairment
What are the DDI’s to Cephalosporins?
- Aminoglycosides (-mycin) - increased risk for nephrotoxicity
- Warfarin - increased risk of bleeding
What are the adverse reactions to Cephalosporin use?
- GI : Nausea, Vomiting, Diarrhea, Flatulence
- Abdominal pain
- Pseudomembranous colitis & C. diff infections and other superinfections
- Nephrotoxicity
- CNS : Headache, Dizziness, lethargy
- Injection site inflammation, irritation, and infection if injected.
Prior to administering Cephalosporin what assessments would we do?
History
* Allergy
* Allergy to Penicillin
* Renal disease
* Pregnancy or lactation
* Physical exam : Abdominal, CNS, skin (injection site adverse effect)
* Vitals
* Labs: C&S, renal function, WBC
What nursing diagnosis could be made prior to giving patients Cephalosporin ?
- Impaired comfort r/t GI and CNS effect
- Infection risk r/t repeated injections
- Dehydration r/t GI effect
- Malnutrition risk r/t Gi effect such as diarrhea
- Knowledge deficit
What implementations should we be doing when giving patients Cephalosporin?
- Check culture and sensitivity reports - right drug
- Monitor renal function during therapy
- Ensure full course is taken as prescribed
- Monitor infection site
- Monitor injection site
- Small, frequent meals, frequent mouth care, ice chips or sugarless candy/lozenges
- Adequate fluids
- Monitor for any signs of superinfection
- Safety measures
- Provide patient teaching
A patient who is receiving cefdinir has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication?
Regular Insulin
Levofloxacin
Warfarin
Bisacodyl
Warfarin
Caution should be used during concurrent use of anticoagulants and cephalosporins due to increased risk of bleeding.
What suffix(es), drug names and potential outliers should we know for Fluoroquinolones?
Have ‘floxacin” in the name (ox in the middle for all)
- Ciprofloxacin
- Levofloxacin
- Moxifloxacin
- Ofloxacin
Is Fluoroquinolones bactericidal or bacteriostatic?
bacteriostatic - prevent growth and reproduction. They are also a broad specter antibiotic.
What are Fluoroquinolones given for?
Bacterial infections
What is absolutely contraindicated in Fluoroquinolones ?
Allergy
What is relatively contraindicated in Fluoroquinolones ?
- Renal dysfunction or Liver impairment
- Myasthenia gravis
- Seizure disorder
What are the known DDI’s to Fluoroquinolones ?
- Iron salts, sucralfate, mineral supplements & antacids - Decrease the effect of Fluoroquinolones due to how they act in the stomach. Should be separated by at least 4 hrs.
- Other drugs that increase the QT interval because Fluoroquinolones also increases QT intervals. This can call fatal cardiac arrythmias.
- Theophylline levels can increase and is dangerous due to narrow safety margins.
- NSAIDs - Increase the CNS effect which can worsen hallucination. BBW.
What are the adverse reactions that can be see with Fluoroquinolones?
- CNS - headache, dizziness, insomnia, depression, hallucinations
- Bone marrow depression
- Photosensitivity
- 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
Prior to giving patients Fluoroquinolones, what should we be assessing?
History: Allergy; myasthenia gravis; seizure disorder; renal or hepatic disease; pregnancy or lactation
Physical exam : Abdominal, CNS, skin, cardiac
Vitals
Labs: C&S, renal function, CBC
Prior to giving patients Fluoroquinolones, what nursing diagnosis can we expect?
- Impaired comfort r/t GI and CNS effect
- Fluid deficit r/t GI effect
- Malnutrition r/t GI effect
- Knowledge deficit
When giving patients Fluoroquinolones, what implementations should we expect and prepare for?
- Check culture and sensitivity reports
- 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, sugarless candy
- Adequate fluids
- Safety measures
- Provide patient teaching esp with the black box warnings
What is a contraindication to receiving a fluoroquinolone?
*Over 65 yrs old
* Weight under 100 lbs
*Allergy to ciprofloxacin
* History of cancer
- Allergy to Ciprofloxacin
Fluoroquinolones are contraindicated in patients with known allergy to any fluoroquinolone and in pregnant or lactating patients because potential effects on the fetus and infant are not known.
What is the suffix(es), drug names and potential outliers for Penicillin and Penicillinase-
Resistant Antibiotics (Penicillins) ?
Have “-icillin” in the name
- Penicillin G benzathine
- Penicillin G potassium
- Penicillin G procaine
- Penicillin V
- Amoxicillin
- Ampicillin
What is the indication for the use of Penicillins?
Bacterial infections
Are Penicillin’s Bactericidal or Bacteriostatic ?
Bactericidal
Penicillin can be used as broad spectrum antibiotics.
True/False
True
What are Penicillinase- resistant antibiotics?
Second generation Penicillin.
What does Penicillinase resistant mean?
Some bacteria produce an enzyme called penicillinase that destroys the beta lactam ring. When the beta lactam ring is destroyed it makes them less effective because the bacteria can get in and degrade the antibiotic.
When antibiotics are Penicillinase resistant they cannot become inactivated by this consequently making it more effective against bacteria.
What are some relative contraindications to Penicillin’s ?
- Allergy to cephalosporins due to cross sensitivity
- Renal disease
What conditions should we be cautious when giving patients Penicillin’s?
Pregnancy and lactation
What are the adverse reactions that we know can happen with Penicillin use?
GI tract due to loss of GI tract flora
Irritation and/or infection at injection site,
Superinfections
Are there any DDI’s with Penicillin’s and if so what are they?
Interactions: parenteral aminoglycosides will be inactivated with parenteral Penicillin.
What assessments should we doing prior to administering Penicillins?
- History: Allergy; renal disease; pregnancy or lactation
- Physical exam : Skin & mucous membrane for rash or lesions.
- Abdominal assessment
- Labs: C&S, renal function, WBC
What nursing diagnosis should we be prepared for prior to administering Penicillins?
- Impaired comfort r/t GI and CNS effect
- Malnutrition r/t GI effect
- Dehydration r/t GI effect
- Knowledge deficit
When we have administered Penicillins, what implementations should we do, be prepared to do?
- Check culture and sensitivity reports
- Monitor renal function
- Ensure patient receives the full course as prescribed
- Take oral routes on an empty stomach
- Monitor the site of infection
- Small, frequent meals; frequent mouth care; ice chips or sugarless candy/lozenges
- Provide adequate fluids
- Monitor the patient for any signs of superinfection
- Monitor and care for injection sites
- Provide patient teaching
What are the suffix(es), drug names and potential outliers for Sulfonamides?
(“-sulfa”) in the name
- sulfadiazine
- sulfasalazine
- trimethoprim-sulfamethoxazole
What indicates the use of Sulfonamides?
Bacterial infections
Is Sulfonamide bactericidal or bacteriostatic?
It is bacteriostatic by inhibiting folic acid synthesis preventing reproduction of the bacteria.
What are the relative contraindications to Sulfonamide?
- Allergy to thiazide diuretics due to cross sensitivity
- Pregnancy: Possibly teratogenic
What are some conditions where we should be cautious of giving Sulfonamide?
Renal disease/kidney stones
What are the DDI’s to Sulfonamides?
Sulfonylureas (antidiabetics) like glyburide & glipizide - increases risk of hypoglycemia.
* Cyclosporine - increased risk of nephrotoxicity.
What are the known adverse reactions to Sulfonamide use?
- GI effects: N/V/D, abdominal pain, stomatitis
- Renal effects : Hematuria, crystalluria, proteinuria, hyperkalemia
- CNS effect : HA, dizziness
- Skin effects : Stevens-Johnson syndrome, photosensitivity
- Bone marrow depression
Prior to administrating Sulfonamides, what do we assess for?
History: Allergies; renal disease; pregnancy or lactation
* Physical Exam: Skin, CNS, abdominal, urinary
* Labs: C&S, renal function, CBC
What are some nursing diagnosis that we should be prepared for prior to giving Sulfonamide?
- Impaired comfort r/t GI and CNS & Skin effect
- Altered sensory perception r/t CNS effect
- Malnutrition r/t GI effect
- Knowledge deficit
When giving Sulfonamides to patients, what implementations should we do / be prepared to do?
- Check C&S reports
- Ensure that the patient receives the full course as prescribed
- Small, frequent meals; mouth care, ice chips or sugarless candy/lozenges
- Adequate fluid intake
- Safety precautions
- Monitor CBC, renal function, and urinalysis results periodically during therapy
- Monitor glucose if patient is on a sulfonylureas
- Provide patient teaching
Sulfonamides should not be given to a patient with an allergy to which drug class because of a cross sensitivity of the drugs?
Thiazine’s (Diuretic)
What are the suffix(es), drug names and potential outliers to Tetracyclines?
“cycline”
* tetracycline
* doxycycline
* minocycline
What is the indication for Tetracyclines?
- Bacterial infections
- Substitute for when Penicillin is contraindicated
Are Tetracyclines Bactericidal or Bacteriostatic ?
Bacteriostatic
What was Tetracyclines developed as?
Semi -synthetic antibiotic based on the structure of common soil mold.
What are the relative contraindications to Tetracyclines?
- Pregnancy and lactation
- Hepatic impairment
When should we exhibit caution with giving Tetracyclines to patients?
When the patient is under 8 yrs old.
Are there any DDI’s with Tetracyclines , if so, what are they?
Digoxin - increases the risk of Dig toxicity.
Are there any food interactions that we should be mindful of when giving patients Tetracyclines?
Administer on empty stomach, 1 hr before of 2 hrs after a meal.
What are the known adverse reactions to Tetracyclines?
- GI effects
- Hepatotoxicity
- Photosensitivity
- Damage to the teeth and bones - which is why we do not give these to children under 8.
- Superinfection
Prior to administrating Tetracyclines, what should we assess for?
History: Allergy; renal or hepatic disease; pregnancy or lactation
* Physical: Skin, skeletal system dye to adverse reaction of teeth and bone, abdomen
* Labs: renal and hepatic function, C&S
What nursing diagnosis can we expect prior to giving patients Tetracyclines?
- Impaired comfort
- Malnutrition
- Altered skin integrity risk
- Knowledge deficit
When administering Tetracyclines to patients, what implementations should we do/ be prepared to do?
- Check culture and sensitivity reports
- Monitor renal and liver function test results
- Ensure patient receives the 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/lozenges
- Monitor for signs of superinfections
- Encourage the patient to apply sunscreen and protective clothing
- Provide patient teaching
What are the other antibiotics that we should know?
- Lincosamides: clindamycin, lincomycin
- Lipoglycopeptides: telavancin, dalbavancin, oritavancin, vancomycin
ADE: Risk of nephrotoxicity; prolonged QT interval; foamy urine - Macrolides: erythromycin, azithromycin, clarithromycin, fidaxomicin
- Fidaxomycin treats C. diff; not absorbed systemically
- Oxazolidinones: tedizolid, linezolid ADE: HTN
- Monobactam: Aztreonam - IV/IM only
What are the suffix(es), drug names and potential outliers for Antimycobacterial/Antituberculosis
Drugs?
Remember R.I.P.E
- Rifampin
- Isoniazid (INH)
- Pyrazinamide
- Ethambutol
When are Antimycobacterial/Antituberculosis Drugs indicated?
- Treatment of TB
- Always used in combination to prevent further resistant strains.
Antimycobacterial/Antituberculosis Drugs are bactericidal
True/False
True
Do we ever use a single medication to treat TB?
No.
What are the relative contraindications to Antimycobacterial/Antituberculosis?
Renal or hepatic failure
Pregnancy and lactation - if we have to treat we will use Isoniazid (INH), Ethambutol and Rifampin with Rifampin determined to be the safest.
Are there any DDI’s that we should be aware of with Antimycobacterial/Antituberculosis?
Rifampin and isoniazid together can cause liver toxicity. If used together then monitor liver function.
What are the known adverse reactions to Antimycobacterial/Antituberculosis drugs ?
- CNS effects
- GI irritation
- Interferes with hormonal birth control
- Rifampin: RED-fampin - discolors bodily fluid a red orange color. Can be an issue for contact lens users.
- Liver toxicity
- Isoniazid (INH) - Interferes with the absorption of B6: neuropathy
- Liver toxicity
- Ethambutol: E=eye - can cause issue with our vision (need periodic eye exams and teach patient ot report blurred vision)
- Baseline and periodic eye exams
- Report blurred vision or color change
Prior to giving Antimycobacterial/Antituberculosis drugs , what should we be assessing for?
- History: Allergy; renal or hepatic disease; pregnancy/lactation
- Physical exam
- Assessment: skin, CNS, GI, respiratory (can show sign of TB returning)
- Labs: renal and hepatic function, C&S
What nursing diagnosis can be made prior to administrating Antimycobacterial/Antituberculosis drugs ?
- Malnutrition r/t GI
- Altered sensory perception (kinesthetic) r/t CNS effect and parathesis
- Impaired comfort r/t GI
- Knowledge deficit
For Antimycobacterial/Antituberculosis drugs what implementations should we be doing during and after drug administration?
- Check culture and sensitivity reports, repeat cultures as needed
- Monitor renal and liver function test results periodically during therapy
- Ensure that the patient receives the full course of the drugs
- Small, frequent meals, perform frequent mouth care, and drink adequate fluids
- Barrier contraceptives
- Provide patient teaching
How long can treatment with TB take?
Up to 2 years with at least 6 months minimum.
What can happen when full dose is not completed?
Resistance strains develop.
What is the Black Box Warning with Fluoroquinolones?
Hallucinations & Tendinitis
