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