Antimicrobial

Question 1

TB Medications

Answer 1

Combination drug therapy, up to 4 meds
Used fro 6-12 months to prevent drug resistance
+ do not drink alcohol
+ monitor for s/s liver damage
+ sputum samples needed every 2-4 weeks
+ pt no longer infectious after 3 negative cultures
+ Pts with active TB need to wear N95 mask in public

Question 2

TB Medications: Isoniazid

Answer 2

Hepatotoxicity

Neuropathy

Question 3

TB Medications: Rifampin

Answer 3

Hepatotoxicity
Orange secretions
GI Upset
Decreases oral contraceptive effectiveness

Question 4

TB Medications: Pyrazinamide

Answer 4

Hepatotoxicity

Question 5

TB Medications: Ethambutol

Answer 5

Changes in vision (E for ethambutol, E for eyes)

Question 6

UTI Medications - Urinary Tract Analgesic

Answer 6

INDICATIONS: SX of UTI (burning, pain, frequency, urgency)
MODE OF ACTION: Acts as a local anesthetic on urinary tract mucosa
SIDE EFFECTS: Orange/red discoloration of urine during tx (can stain clothes)

NOT an antibiotic. It treats symptoms of UTI

Question 7

UTI Medications - Antibiotics (3)

Answer 7

1) Sulfamethoxazole-trimethoprim
2) Nitrofurantoin
3) Ciprofloxacin:

Question 8

UTI Medications - Antibiotics - Sulfamethoxazole-trimethoprim

Answer 8

MODE OF ACTION: inhibits bacteria folic acid synthesis

SIDE EFFECTS: GI upset, hypersensitivity, blood dycrasias (monitor CBC), photosensitivity (wear sunscreen), crystalluria (increase fluid intake)

Question 9

UTI Medications - Antibiotics - Nitrofurantoin

Answer 9

MODE OF ACTION: Urinary tract antiseptic; damages bacterial DNA

SIDE EFFECTS: GI upset, hypersensitivity, blood dycrasias, peripheral neuropathy, brown discoloration of urine during treatment

Question 10

UTI Medications - Antibiotics - Ciprofloxacin (Fluoroquinolone)

Answer 10

MODE OF ACTION: Prevents bacteria DNA replication

SIDE EFFECTS: GI upset, achilles tendon rupture, superinfection, photosensitivity (wear sunscreen)

Question 11

Antibiotic for serious infections: Vancomycin (Vancocin)

Answer 11

INDICATIONS: Serious infections and antibiotic-associated CDIFF infection.

MODE OF ACTION: Destroys bacteria cell wall, causing cell death.

SIDE EFFECTS: Ototoxicity, Nephrotoxicity, infusion reactions, phlebitis

KEY POINTS: Monitor vancomycin tough levels (and possibly peak levels). Dose may need to be adjusted depending on creatinine levels.

If pt expected to be on this for extended period of time, it is to be administered through PICC line.

Question 12

Aminoglycosides: Gentamicin

Answer 12

INDICATIONS: Serious bacterial infections

MODE OF ACTION: Destroys bacteria by inhibiting protein synthesis (bactericidal)

SIDE EFFECTS: Ototoxicity, Nephrotoxicity, vertigo, ataxia

KEY POINTS: Monitor patient for tinnitus & hearing loss. Monitor for kidney function (creatinine levels, I&Os, observe urine for hematuria). Administer IM or IV. Monitor peak/trough blood levels.

Question 13

Tetracyclines

Answer 13

INDICATIONS: Bacterial infections, acne, Lyme disease.

MODE OF ACTION: Prevents protein synthesis, inhibiting bacterial growth) (bacteriostatic = slows/inhibits growth)

SIDE EFFECTS: GI upset, tooth discoloration in children (and fetuses), hepatotoxicity, photosensitivity, superinfection (CDIFF, yeast infection).

KEY POINTS:
+ Do not give to pregnant women or children under 8 years of age.
+ Wear sunscreen.
+ Should be taken on an empty stomach w/full glass of water.
+ Decreases effectiveness of oral contraceptives.
+ Dairy products (such as milk), foods high in calcium, and antacids decrease absorption.

Question 14

Carbapenems: imipenem-cilastatin (Primaxin)

Answer 14

INDICATIONS: Serious bacterial infections (broad spectrum)

MODE OF ACTION: Destroys bacteria cell wall, causing cell death.

SIDE EFFECTS: GI upset, rash, superinfection, (CDIFF, yeast infection),

KEY POINTS: Patients allergic to penicillin and/or cephalosporin may have an allergic reaction to carbapenems.

Question 15

Cephalosporins: Cephalexin (Keflex)

Answer 15

Other cephalosporins: Cefazolin, ceftriaxone, (many start with cef)

INDICATIONS: Bacterial infections

MODE OF ACTION: Weakens bacterial cell wall, causing cell death.

SIDE EFFECTS: GI upset, allergies (dyspnea, rash), superinfection (CDIFF, yeast infection).

KEY POINTS; Do not give to patients with a history of allergies to penicillin. Do not consume alcohol during therapy. Take with food.

Question 16

Penicillins: penicillin (narrow spectrum), amoxicillin (broad spectrum)

Answer 16

OTHER PENICILLINS: Piperacillin, tazobactum, most end in -cillin

INDICATIONS: bacterial infections.

MODE OF ACTION: Weakens bacterial cell wall, causing cell death.

SIDE EFFECTS: Gi upset, allergies (dyspnea, rash), nephrotoxicity.

KEY POINTS: Do not give to patients with history of allergies to penicillin or cephalosporin. Monitor for allergic response.

Question 17

Macrolides: erythromycin(E-Mycin)

Answer 17

OTHER MACROLIDES: Azithromycin (Zithromax)

INDICATIONS: Bacterial infections.

MODE OF ACTION: Inhibits protein synthesis, slowing bacterial growth. (i.e., bacteriostatic)

SIDE EFFECTS: GI upset, dysrhythmias, ototoxicity.

KEY POINTS; Take on an empty stomach with full glass of water.

Question 18

Antiviral Medications:
+ acyclovir (Zovirax)
+ ganciclovir (Cytovene)

Answer 18

INDICATIONS:

acyclovir: sx of herpes, varicella-zoster viruses
ganciclovir: sx of cytomegalovirus

MODE OF ACTION (both): Prevents viral DNA synthesis.

SIDE EFFECTS (both):  Phlebitis, GI upset, nephrotoxicity
\+ ganciclovir only:  bone marrow suppression (anemia, neutropenia, thrombocytopenia)

KEY POINTS: Meds to not CURE conditions. For patients taking ganciclovir, monitor CBC levels, signs of infection.

Question 19

Systemic Antifungals:
+ amphotericin B (Fungizone)
+ ketoconazole (Nizoral)

Answer 19

INDICATONS: Systemic fungal infections.

SIDE EFFECTS:
+ amphotericin B: Highly toxic (only for life-threatening fungal infections), Hepatatotoxicity, GI upset, nephrotoxicity, bone marrow suppression, phlebitis.
+ ketoconazole: Hepatotoxicity, GI upset.

KEY POINTS: Administer test dose of amphotericin B for patient reaction. Monitor for liver dysfunction (sx: pale stools, dark urine, n/v, fatigue, jaundice).

Question 20

Antiprotozoals:

+ metronidazole (Flagyl)

Answer 20

INDICATIONS: Bacterial and protozoal infections.

MODE OF ACTION: Inhibits DNA and protein synthesis; effective against anaerobic bacteria.

SIDE EFFECTS: GI upset, metallic taste, dark urine, dizziness, headache.

KEY POINTS: Do not drink alcohol.