Antiinfectives Flashcards
Penicillin Overview
MOA: inhibits bacterial wall synthesis
Indications: streptococcus and staphylococcus infections
Contraindications: drug allergy
Adverse Effects: allergic reaction in 0.7-4%, nausea, vomiting, diarrhea
Interactions: aminoglycosides, NSAIDs, oral contraceptives (reduce effectiveness- use different form of BC), warfarin
Nursing Considerations for Penicillin
Determine if patient is allergic to drug
Educate them about decreased effectiveness of birth control
Take drug with food to decrease GI upset
Finish entire course of antibiotics to reduce antibiotic resistance (no longer effective for MRSA)
Penicillin Key Drugs
penicillin G: given IV or IM, treats STD syphillis
amoxicillin: very common, treats infections in ears, nose, throat, GU tract, skin, and skin structures
Cephalosporin Overview
MOA: interfere with bacterial wall synthesis
Indications: effective BROAD spectrum antibiotic (covers both G+ and G- bacteria– makes it a good drug to start treating infection before lab results come back)
Contraindication: allergy to Penicillins
Adverse Effects: diarrhea, abdominal cramps, rash, edema
Interactions: alcohol, antacids (decrease oral absorption), oral contraceptives
Nursing Considerations for Cephalosporin
Determine if patient is allergic to penicillin, because of the potential for cross-susceptibility.
Wait two hours after taking antacid to take cephalosporin.
Use different BC method
Cephalosporin Key Drugs
cefazolin: prophylaxis in surgery to prevent surgical infection
cephalexin: streptococcus and staphylococcus infections (oral)
cefoxitin: abdominal surgeries d/t effectiveness against abdominal organisms
ceftriaxone: long acting; treats meningitis d/t ability to cross BBB, also be given IM (can be a painful injection, but may only need one dose!)
Macrolide Overview
MOA: bacteriostatic drugs which inhibit protein synthesis
Indications: wide variety of infections (somewhat broad spectrum)
Contraindications: known drug allergy
Adverse Effects: GI related- especially nausea and vomiting with bad diarrhea ***excel at bad GI effects
Interactions: competitive with many drugs because it is highly protein bound and metabolized in the liver
Nursing Considerations for Macrolides
Stay hydrated, do not drink alcohol, take with food to help the GI effects, take first dose at home (to see how it effects you), no juice (because it is acidic and can contribute to GI effects)
Macrolide Key Drugs
erythromycin: respiratory and GI infections (but a lot of patients cannot tolerate GI effects), topical for dermatological use
azithromycin: upper and lower respiratory infections (Z PACK)
clarithromycin- GU and respiratory infections
Overview of Tetracyclines
MOA: inhibit protein synthesis in susceptible bacteria
Indications: treatment of acne in adolescents and adults (most common use); but also, treatment of Chlamydia, Mycoplasma, & Rickettsia
Contraindications: avoid in pregnant and nursing women (potential for birth defects), and children younger than 8 years old (discoloration of teeth and reduction of tooth enamel)
Adverse Effects: photosensitivity, GI upset, hematologic abnormalities
Interactions: antacids, dairy products, calcium, enteral feedings, and iron preparations (reduce oral absorption)
Nursing Considerations for Tetracyclines
Use SUN PROTECTION, almost better off not going into the sun
Make sure patient is not pregnant or breast feeding
Schedule monthly blood work
Take milk, calcium, and iron at least two hours apart from medication!
Tetracycline Key Drugs
doxycycline: very common, treats Rickettsial infections, chlamydial infections, and mycoplasmal infections. Also used in treatment of acne– make sure to educate patients on adverse effects
Overview of Aminoglycosides
MOA: prevent protein synthesis in bacteria
Indications: serious infections due to toxicity
Contraindications: not for use in pregnant women d/t crossing placenta (potentially causes congenital deafness)
TOXICITIES: nephrotoxicity, ototoxicity, neurotoxicity
Interactions: other nephrotoxic drugs like vancomycin, cyclosporine & amphotericin B
Nursing Considerations of Aminoglycosides
This drug is ONLY used for SERIOUS infections because of potential adverse effects.
Watch for nephrotoxicity: Monitor I&Os, watch for increase in BUN and Creatinine, check GFR, check urine for albumin
Watch for ototoxicity: tinnitus, feeling of fullness in ears
Watch for neurotoxicity: balance issues, paresthesias (numbness/tingling) in arms/legs
Should get ready to stop medication and call the doctor if any of these signs or symptoms occur.
Do not restrict fluids because of possible nephrotoxicity.
Aminoglycosides Key Drugs
amikacin: treats infections which are resistant to gentamicin or tobramycin
gentamicin: most commonly used aminoglycoside; treatment of G+ and G- infections… make sure there are labs ordered to verify kidney function!
Overview of Quinolones
MOA: destroy bacteria by altering their DNA (cannot continue to replicate)
Indications: complicated UTIs, respiratory, skin, GI and bone&joint infections
Contraindications: known drug allergies
Adverse Effects: prolongation of QT interval on ECG& dangerous cardiac dysrhythmias when given with amiodarone
Interactions: antacids, calcium, magnesium, iron, zinc, or sucralfate– reduce oral absorption
Nursing Considerations for Quinolones
Monitor heart rate and rhythm, watch ECG.
Clarify doctors orders if prescribed with amiodarone.
Give other meds that reduce oral absorption at least two hours apart.
Quinolones Key Drugs
ciprofloxacin: broad spectrum; effective against wide range of G- bacteria; used to treat complex UTIs; drug of choice in treatment of anthrax
Make sure it is not prescribed with amiodarone!
Miscellaneous- clindamycin
MOA: inhibits protein synthesis
Indications: treats chronic bone infections (osteomyelitis), GU tract infections, intraabdominal infections, pneumonia, septicemia, serious skin and soft-tissue infections
Contraindications: less than 1 month of age, ulcerative colitis (because of GI AE)
Adverse Effects: GI- nausea, vomiting, diarrhea
Nursing Considerations for clindamycin
Clindamycin is normally prescribed for treatment over a long period of time, which creates the potential for a super infection because it decreases the normal flora so otehr bacteria can pop up and grow.
Monitor for C. diff infection. If possible, keep normal flora up with probiotics, wash hands, good hygiene (for nurse and patient).
Take with food to help with GI- don’t put hands in mouth.
Miscellaneous- metronidazole
MOA: antimicrobial
Indications: treats intraabdominal and gynecologic anaerobic infections
Adverse effects: dizziness, HA, GI discomfort, nasal congestion
Interactions: alcohol,, lithium, benzodiazepines, cyclosporine, CCBs, venlafaxine, and warfarin
Nursing Considerations for metronidazole
Avoid alcohol at all costs (at least 24 hours before or 36 hours after). Explain that it accelerates depressive effects of alcohol.
Lithium and benzodiazepines can cause an additive effect and create greater CNS depression.
In combination with warfarin, it can cause extra bleeding effects: long time to form clot, extra bruises.
Miscellaneous- vancomycin
MOA: bactericidal antibiotic
Indications: choice antibiotic for treatment of MRSA infection
Contraindications: pre-existing renal impairment and hearing loss d/t toxicities
Adverse Effects: red man syndrome, ototoxicity, nephrotoxicity
Interactions: other nephrotoxic drugs (gentamicin, amikacin, cyclosporine, amphotericin B, etc)
Nursing Considerations for vancomycin
Make sure kidney labs ordered (watch for increase in BUN and Cr+, monitor I&Os)
Have to wait for lab to come draw blood before giving vancomycin (Look at trough levels– lowest amount in system)
Pay attention to rate at which to administer via IV infusion– if it is infused too fast, can start flushing in head and neck (red man syndrome)
