Antiinfectives Flashcards
Signs of infection
fever, chills, pain, redness, swelling, increased WBC, pus/purulent drainage
Community associated infection
acquired by person not recently hospitalized w/in past year
-no medical procedures involved
Health care associated infection
aka “nosocomial infection”
- acquired by pt receiving treatment for other condition in health care facility
- MRSA = most common
- resistant to multiple antibiotics
superinfections
occur when antibiotics reduce or eliminate normal bacterial flora
antibiotic resistance
bacterial infections become resistant to antibiotics d/t many factors
Penicillins
MOA: inhibits bacterial cell wall synthesis
Indications: streptococcus, and staphylococcus
Contraindications: drug allergy
Adverse Effects: allergic reaction in 0.7% - 4%, nausea, vomiting, diarrhea
Interactions: aminoglycosides, NSAID’s, oral contraceptives, warfarin
Nursing Considerations: allergy to drug
Penicillin G
Given IV/IM
Treats: STD syphilis
Amoxicillin
very commonly prescribed
treats: ear, nose, throat, GU tract, skin and skin structure infections
Cephalosporins
MOA: interfere with bacterial cell wall synthesis
Indications: effective broad spectrum antibiotics
Contraindications: allergy to Penicillins
Adverse Effects: diarrhea, abdominal cramps, rash, edema
Interactions: ETOH, antacids, oral contraceptives
Nursing Considerations: never give to someone who has an allergy to penicillins; contraceptives
Cefazolin
Cephalosporin
prophylaxis in sugery
cephalexin
Cephalosporin
treats: streptococcus and staphylococcus infections
cefoxitin
Cephalosporin
treats: abd surgeries d/t effectiveness against abd organisms
ceftriaxone
Cephalosporin
long acting
treats: meningitis d/t ability to cross BBB
also given IM
Macrolides
MOA: bacteriostatic drugs which inhibit protein synthesis
Indications: wide variety of infections
Contraindications: known drug allergy
Adverse Effects: GI related: especially nausea and vomiting
Interactions: many drugs due to highly protein bound and metabolized in the liver
Nursing Considerations: n/v, stay hydrated, no alcohol, take with food, don’t take with acidic juice
erythromycin
respiratory and GI infections
topical for dermatological use
can cause very severe GI AE’s
azithromycin
upper and lower respiratory infections
clarithromycin
GU and respiratory infections
Tetracyclines
MOA: inhibit protein synthesis in susceptible bacteria
Indications: treatment of acne in adolescents & adults, treatment of Chlamydia, Mycoplasma, & Rickettsia
Contraindications: avoid in pregnant and nursing women, & children younger than 8 years old
Adverse Effects: photosensitivity, GI upset, hematologic abnormalities
Interactions: antacids, dairy products, calcium, enteral feedings, & iron preparations reduce oral absorption
Nursing Considerations: pregnant, don’t give to children under 8 (changes color of teeth), sun protection, antacids
doxycycline
very common
treats Rickettsial infections chlamydial infections, mycoplasmal infections
*also used for acne
aminoglycosides
MOA: prevent protein synthesis in bacteria
Indications: serious infections due to toxicity
Contraindications: not for use in pregnant women d/t crossing placenta
Adverse Effects: serious toxicities such as nephrotoxicity, ototoxicity, & neurotoxicity
Interactions: other nephrotoxic drugs like vancomycin, cyclosporine, & amphotericin B
Nursing Considerations: allergy, pregnancy, assess for ringing in the ears, balance issues
amikacin
aminoglycoside
treats infections that are resistant to Gentamicin or Tobramycin
call dr if renal labs have not been ordered
gentamicin
most commonly used aminoglycoside
treats: gram - / + infections
call dr if renal labs have not been ordered
Quinolones
MOA: destroy bacteria by altering their DNA
Indications: complicated UTI’s, respiratory, skin, GI, and bone & joint infections
Contraindications: known drug allergy
Adverse Effects: prolongation of QT interval on ECG & dangerous cardiac dysrhythmais when given with amiodarone
Interactions: antacids, calcium, magnesium, iron, zinc or sucralfate reduces oral absorption
Nursing Considerations: ????
Ciprofloxacin
- Broad spectrum Quinolone
- Effective against wide range of gram negative bacteria
- Treatment of UTI’s
- Drug of choice in treatment of anthrax
- don’t take w/ amiodarone
clindamycin
inhibits protein synthesis
Treats chronic bone infections, GU tract infections, intra-abdominal infections, pneumonia, septicemia, serious skin and soft-tissue infections
Contraindications: less than 1 month of age, ulcerative colitis
Adverse effects: GI: nausea, vomiting, diarrhea
Can cause C. difficile (c. diff) infection
Nursing Considerations:????
Metronidazole
Antimicrobial drug
Treats intraabdominal and gynecologic anaerobic infections
Adverse effects: dizziness, HA, GI discomfort, nasal congestion
Interactions: avoid alcohol; lithium, benzodiazepines, cyclosporine, CCB’s, venlafaxine, and warfarin
Nursing Considerations: avoid alcohol! watch for dizziness, HA
vancomycin
Bactericidal antibiotic
Choice antibiotic for treatment of MRSA infection
Contraindications: pre-existing renal impairment and hearing loss d/t toxicities
Adverse effects: red man syndrome, ototoxcity, nephrotoxicity
Interactions: other nephrotoxic drugs such as???
Nursing Considerations: make sure renal labs have been ordered; take trough levels (when the effect is the lowest, has lowest amt in system) - want to stay at a specific level; pay attention to IV infusion rate
Antivirals: Non-HIV
MOA: blocks enzymes that promote synthesis of new viral genomes
Indications: Herpes Simplex Virus, chickenpox, cytomegalovirus
Contraindications: severe drug allergy
Adverse Effects: specific to each drug Table 40-2
Interactions: CNS stimulants, antibiotics
Nursing Considerations:????
Acyclovir
antiviral - non-HIV
Drug of choice for initial and recurrent herpes infections
Oral, topical and injectable formulas
Ganciclovir
antiviral - non-HIV
Treatment of infections caused by CMV (cytomegalovirus)
Dose limiting toxicity is bone marrow suppression
Antiretrovirals: HIV Drugs
MOA: varies depending on type of medication
Indications: only indication is active HIV infection
Contraindications: severe drug allergy or intolerable toxicity
Adverse Effects: specific to each medication
Interactions: oral contraceptives, antivirals
Nursing Considerations:????
Indinavir
Antiretroviral
- Protease inhibitor
- Taken in combo w/ other HIV drugs or alone
- Best absorbed if given in a fasting state
Nevirapine
Antiretroviral
- NNRTI (nonnucleoside reverse transcriptase inhibitor)
- Better tolerated adverse effects than other HIV drugs
zidovudine
Antiretroviral
- Safe in pregnant women & newborns
- Nucleoside reverse transcriptase inhibitor
- Causes bone marrow suppression
Antituberculars
MOA: inhibit protein synthesis or inhibit cell wall synthesis
Indications: treatment of TB infections
Contraindications: renal and liver dysfunction
Adverse Effects: pyridoxine (vitamin B6) deficiency and liver toxicity
Interactions: antacids, seizure medications, anticoagulants
Nursing Considerations:????
Isoniazid
- Most widely used antitubercular drug
- Given as single drug for prophylaxis or in combo for treatment
- Inhibits cell wall synthesis
- “Slow acetylators”
Antifungals
MOA: varies with each drug
Indications: specific to each antifungal
Contraindications: liver failure, kidney failure
Adverse Effects: most commonly occur with amphotericin B treatment
Interactions: many drugs d/t metabolism by specific liver enzymes
Nursing Considerations: liver/kidney labs
Amphotericin B
Drug of choice for severe systemic fungal infections
Severe adverse effects- cardiac arrhythmias and nephrotoxicity
Infusion related effects- fever, tachycardia, N/V, headache, etc.
AKA “Amphoterrible”
Fluconazole
Good coverage against many fungal infections
Better adverse effect profile than Ampotericin B
Oral and injectable forms
