Antibiotics 2 Flashcards
Regarding vancomycin, describe route of absorption, therapeutic uses, and major adverse effects (some content is in small print). Differentiate vancomycin flushing syndrome or infusion reaction from anaphylaxis
Vanco is absorbed poorly through the GI tract, so for most infections it is given parenterally (by slow IV infusion). Oral administration is employed only for infections of the intestine, mainly CDI.
Anaphylaxis is when the patient cannot breathe and is showing signs and symptoms of being SOB and angioedema after getting an infusion of vancomycin.
Vancomycin flushing syndrome (VFS) is an anaphylactoid reaction caused by the rapid infusion of the glycopeptide antibiotic vancomycin. VFS consists of a pruritic, erythematous rash to the face, neck, and upper torso, which may also involve the extremities to a lesser degree.
List symptoms for Clostridium difficile infection, risk factors, efforts to control (Box 85-1).
C Diff is defined by the passage of three or more unformed stools in 24 hours or less plus a positive stool test for C diff. Symptoms range from watery diarrhea to life-threatening pseudomembranous colitis characterized by patches of severe inflammation and purulent drainage.
risk factors for C diff infection are: treatment with antibiotics. Risk is especially high among older adults who take antibiotics. Other risk factors include GI surgery, serious illness, prolonged hospitalization, and immunosuppression.
efforts to control C diff are: contact isolation (gloves, gown, mask), WASH HANDS WITH SOAP, disposable rectal thermometers, bleach decontaminating agent.
List important points on patient teaching for vancomycin.
Vancomycin: instruct patients to complete the prescribed course of therapy even though symptoms may abate before the full course is over.
Regarding Tetracyclines; describe mechanism of action, therapeutic uses, absorption, and adverse effects.
MOA: suppress bacterial growth by inhibiting protein synthesis in the mRNA.
therapeutic uses: rickettsial diseases (rocky mountains spotted fever, typhus fever, Q fever), infections caused by Chlamydia trachomatis, brucellosis, cholera, mycoplasma pneumoniae infections, lyme disease, anthrax, gastric infection with H. pylori.
absorption: all are orally effective, the extent of absorption differs among individual agents. Food slows down absorption for tetracycline, demeclocycline, and doxycycline.
ae’s: GI irritation, discolored teeth and bones, suprainfection.
Don’t give to children younger than 8 years, hepatotoxicity, renal toxicity, photosensitivity, vestibular toxicity, pseudo tremor cerebri (a benign elevation in ICP). Demeclocycline has produced nephrogenic diabetes insipidus (unusual thirst, increased urination, and weakness). Can cause pain at sites of IM injections and thrombophlebitis at IV sites.
Explain food and drug interactions with tetracyclines.
CHELATES: do not give with milk products, calcium supplements, magnesium containing laxatives, and most antacids.
can increase digoxin levels
can increase INR levels.
pts. on digoxin or warfarin and tetracyclines should also undergo careful drug monitoring.
How is doxycycline different from other tetracyclines?
prolonged half-life and improved oral absorption.
Regarding the macrolide erythromycin, describe MOA, therapeutic uses, absorption, adverse effects, and important drug interactions.
MOA: blocks the protein synthesis in the ribosomal subunit and blocks the addition of amino acids to the growing peptide chain.
absorption: food decreases absorption, IV dosing produces drug levels that are higher than those achieved with oral dosing.
ae’s: GI: N/V, pain, diarrhea, suprainfection of the bowel. Cardiac: Qt prolongation and sudden cardiac death.
interactions: CYP450 drugs will have increased plasma levels if given concurrently with erythromycin. these drugs include: theophylline, carbamazepine, and warfarin.
it also prevents the binding of chloramphenicol and clindamycin to bacterial ribosomes, thereby antagonizing their bacteriacidal effects. Don’t use concurrently
Recognize azithromycin as a macrolide (similar nursing implications as erythromycin) and list therapeutic uses.
therapeutic uses: respiratory tract infections, skin infection, cholera, disseminated mycobacterium avium
List major points of patient teaching for tetracyclines and macrolides.
Tetracyclines: take with a full glass of water, 1 hour before meals or 2 hours after. Minocycline may be taken with food. allow 2 hours between ingestion of macrolides and these chelators: milk products, calcium supplements, magnesium-containing laxatives, and most antacids. Instruct patients to complete the prescribed course of treatment, even though symptoms may abate before the full course is over.
Inform patients that GI distress can be reduced by taking tetracyclines with meals, though absorption can be reduced. Have them notify provider if significant diarrhea develops. Inform patients about symptoms of fungal infection (vaginal or anal itching, inflammatory lesions of the tongue, black furry appearance of the tongue) and call hcp if these happen. Advise patients to avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin.
macrolides: erythromycin:
advise patients to take oral preparations on an empty stomach and with a full glass of water unless GI upset, then can do them with meals. Have them complete the whole course of treatment. Inform patients using erythromycin ethylsuccinate and enteric coated formations that these can be taken without regard to meals. Advise patients to notify the provider if GI reactions are severe or persistent. Instruct patient to take oral clindamycin with a full glass of water. Instruct patients to report significant diarrhea (more than five watery stools per day).
Other bacteriostatic inhibitors: Clindamycin (therapeutic use, adverse effects),
therapeutic use: alternative to penicillin because of it’s wide efficacy against gram positive cocci. primarily for anaerobic infections outside of the CNS. drug of choice for sever group A streptococcal infection and gas gangrene. Also for abdominal and pelvic infections caused by B. fragilis.
adverse effects: CDAD, hypersensitivity reactions, diarrhea that is not CDAD. hepatotoxicity. Rapid IV admin can cause electrocardiographic changes, hypotension and cardiac arrest.
Linezolid (Therapeutic use, adverse effects, drug interactions).
therapeutic use: infections caused by VRE, healthcare associated pneumonia cause by staph aureus, community associated pneumonia caused by strep. pneumoniae, complicated skin and skin structure infections, uncomplicated skin and skin structure infections.
interactions: weak inhibitor of MAOs and can cause hypertensive crisis. Combined with a SSRI can increase risk of serotonin syndrome.
ae’s: diarrhea, nausea, headache. reversible myelosuppression (manifests as anemia, leukopenia, thrombocytopenia). risk is related to the duration of use. CBC weekly. prolonged therapy is associated with neuropathy.
Describe risk factors for Methicillin Resistant Staph Aureus (MRSA).
risk factors: hospital/healthcare: advanced age, recent surgery or hospitalization, dialysis, treatment in an ICU, prolonged antibiotic therapy, indwelling catheter, residence in a long term care facility.
Community acquired MRSA: living in close quarters (family members, day care clients, prison inmates, military personnel, college students).
Which antibiotics are used to treat MRSA?
Ceftaroline
