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NURS 3303 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Penicillin G (benzylpenicillin) MOA

A

target PCN-binding proteins to weaken bacterial cell wall through inhibition of transpeptidases and dishinibition of autolysins

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2
Q

Penicillin G (benzylpenicillin) indications

A

most used for infections caused my most gram + bacteria (i.e., strep, enterococcus, and staph)

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3
Q

Penicillin G (benzylpenicillin) AEs

A
  • generally well-tolerated
  • allergic reactions possible (cross allergy with cephalosporins possible)
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4
Q

Penicillin G (benzylpenicillin) nursing considerations

A
  • assess for hx of allergic rxn S/S
  • monitor CBC, V/S, and infection S/S
  • c. diff possible
  • consider co-administration with lactobacillus
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5
Q

piperacillin/tazobactam (Zosyn) MOA

A

penicillin actions plus inhibition of bacterial beta-lactamase with tazobactam

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6
Q

piperacillin/tazobactam (Zosyn) indications

A

extended spectrum (penicillin susceptible organisms plus gram - and anaerobic coverage including, pseudomonas, enterobacter, Klebsiella)

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7
Q

piperacillin/tazobactam (Zosyn) AEs

A
  • low toxicity
  • allergic reactions
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8
Q

piperacillin/tazobactam (Zosyn) nursing considerations

A
  • same as Penicillin G plus:
  • parenteral route only
  • monitor IV infusion site and compatibility with other IV meds
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9
Q

cephalosporins MOA

A

bind to penicilllin-binding proteins to disrupt cell wall synthesis and activate autolysins

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10
Q

cephalosporins indications

A
  • Cefazolin (Ancef) = surgical prophylaxis
  • Cefepime (Maxipime) = resistant organisms
  • Ceftaroline (Teflaro) = skin infections and HCAP
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11
Q

cephalosporins AEs

A
  • allergic reactions
  • bleeding tendenies through interference with vitamin K metabolism
  • Disulfiram-like rxns with alcohol
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12
Q

cephalosporins nursing considerations

A
  • assess for history of allergic rxn S/S
  • monitor CBC, V/S, and infection S/S
  • c. diff infection possible
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13
Q

imipenem/cilastatin (Primaxin) MOA

A

binds specifically to PBP 1 & 2 to weaken cell wall and can resist beta-lactamases

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14
Q

imipenem/cilastatin (Primaxin) indications

A
  • very broad spectrum with activity against most pathogens including MDRO, for bone, joint, SSTI, UTI, intraabdominal, and pelvic infections
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15
Q

imipenem/cilastatin (Primaxin) AEs

A
  • generally well-tolerated
  • GI upset most common
  • seizures (mainly w/ renal impaired pts)
  • superinfections
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16
Q

imipenem/cilastatin (Primaxin) nursing considerations

A
  • co-admin with cilastatin to prevent rapid imipenem breakdown in kidneys
  • reserve use in pts with infections not covered by other antibiotics
  • seizure precautions as needed
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17
Q

Vancomycin (Vancocin) MOA

A

inhibits cell wall synthesis by binding to molecules that serve as precursors for cell wall biosynthesis

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18
Q

Vancomycin (Vancocin) indications

A

include gram + coverage only for bone, joint, and bloodstream infections (MRSA, c. diff)

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19
Q

Vancomycin (Vancocin) AEs

A
  • nephrotoxicity leading to renal failure
  • ototoxicity
  • red man syndrome
  • VRE
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20
Q

Vancomycin (Vancocin) nursing considerations

A
  • usually administered IV; PO admin for CDI
  • monitor trough levels and CMP for renal function
  • avoid concurrent use with other nephrotoxic medications
  • appropriate hygiene and cleaning with active CDI pts
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21
Q

doxycycline MOA

A

bacteriostatic abx that binds to 30S ribosomal subunit to inhibit binding of transfer RNA to mRNA to inhibit protein synthesis

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22
Q

doxycycline indications

A

broad spectrum coverage against many gram + and - organisms

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23
Q

doxycycline AEs

A
  • GI upset most common
  • bone growth suppression and teeth discoloration in peds pts
  • fatty liver infiltration and renal impairment exacerbation
  • alterations in normal flora and superinfections
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24
Q

doxycycline nursing considerations

A
  • decreased absorption if given with metal ions (Ca, Fe, and Mg; admin on empty stomach if tolerated)
  • hepatic and renal monitoring
  • avoid prolonged sunlight exposure and apply protective measures
  • interactions with oral contraceptives and anticoagulants
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25
Q

erythromycin MOA

A

bacteriostatic abx that binds to 50S ribosomal subunit to block addition of new amino acids to growing peptide chain

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26
Q

erythromycin indications

A

most gram + and some gram - coverage

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27
Q

erythromycin AEs

A
  • GI upset most common
  • QT prolongation
  • hepatotoxicity and ototoxicity
  • numerous medication interactions
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28
Q

erythromycin nursing considerations

A
  • often first alternative to PCN sensitive bacterial infections if allergy is present
  • administer PO on empty stomach to maximize absorption; can give with food if upset stomach persists
  • avoid in pts with pre-existing QT prolongation; monitor on tele
  • can increase half lives of several medications (theophylline and warfarin)
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29
Q

clindamycin (Cleocin) MOA

A

similar to macrolides; bacteriostatic abx that binds to 50S ribosomal subunit to block addition of new amino acids to growing peptide chain

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30
Q

clindamycin (Cleocin) indications

A

gram + and gram - anaerobes and most gram + aerobes

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31
Q

clindamycin (Cleocin) AEs

A
  • severe to fatal c. diff colitis (characterized by abd pain, leukocytosis, and fever)
  • non-c. diff diarrhea
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32
Q

clindamycin (Cleocin) nursing considerations

A
  • monitor and educate pts on monitoring stool and fluid status
  • > 5 loose stools per day concerning for CDAD and consider D/C treatment
  • vigorous fluid and electrolyte replacement with vancomycin treatment
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33
Q

linezolid (Zyvox) MOA

A

bacteriostatic abx that binds to 23S portion of 50S ribosomal subunit to block formation of intitiation complex

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34
Q

linezolid (Zyvox) indications

A

very broad spectrum coverage including MDRO

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35
Q

linezolid (Zyvox) AEs

A
  • HA, GI upset
  • myelosuppression (anemia, leukopenia, and/or thrombocytopenia)
  • optic and peripheral neuropathy
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36
Q

linezolid (Zyvox) nursing considerations

A
  • monitor CBC and I/O
  • give w/ food to limit GI upset
  • monitor for drug interactions with MAOIs and SSRIs
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37
Q

gentamicin MOA

A

binds to 30s ribosomal subunit to inhibition protein synthesis, premature termination of protein synthesis, and production of abnormal proteins; causes bactericidal activity effects that persist via postantibiotic effect

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38
Q

gentamicin indications

A

gram + cocci and aerobic gram - bacilli (e. coli, Klebsiella, pseudomonas); primarily used for serious infections

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39
Q

gentamicin AEs

A
  • nephrotoxicity (due to proximal renal tubule injury)
  • ototoxicity (impairing both hearing and balance)
40
Q

gentamicin nursing considerations

A
  • assess serum peak and trough, UOP, and CMP
  • neuro focused (hearing, balance especially if concurrent use of ototoxic agents)
41
Q

sulfamethoxazole/trimethoprim (Bactrim) MOA

A

bacteriostatic medications that inhibit tetrahydrofolate synthesis that is needed to make DNA, RNA, and proteins

42
Q

sulfamethoxazole/trimethoprim (Bactrim) indications

A

broad spectrum against gram + and gram - (UTI, nocardiosis, Listeria, and P. jiroveci)

43
Q

sulfamethoxazole/trimethoprim (Bactrim) AEs

A

sulfonamide AEs
- photo and hypersensitivity rxns (SJS/TENS)
- hemolytic anemia
- Kernicterus in newborns
- renal damage from crystalline aggregates
trimethoprim AEs
- megaloblastic anemia
- hyperkalemia

44
Q

sulfamethoxazole/trimethoprim (Bactrim) nursing considerations

A
  • monitor for rash and stop immediately if present
  • cross allergies with other sulfa-containing meds
  • monitor CBC and CMP and progression of infection S/S
45
Q

nitrofurantoin (Macrobid) MOA

A

after conversion to reactive form, causes bacterial injury due to inhibition of protein, DNA, RNA, and protein synthesis, as well as energy metabolism

46
Q

nitrofurantoin (Macrobid) indications

A

broad spectrum against gram + and gram - (treatment and prophylaxis of acute lower UTI)

47
Q

nitrofurantoin (Macrobid) AEs

A
  • GI upset most common
  • pulmonary rxns (dyspnea, cough, malaise)
  • hematologic effects (leukopenia, thrombocytopenia, and megaloblastic anemia)
48
Q

nitrofurantoin (Macrobid) nursing considerations

A
  • not indicated for upper UTI
  • encourage increased water intake and cranberry juice to avoid other potential nephrotoxic drugs
49
Q

ciprofloxacin (Cipro) MOA

A

inhibits two enzymes needed for DNA replication and cell division

50
Q

ciprofloxacin (Cipro) indications

A

broad spectrum against most aerobic gram - and some gram +

51
Q

ciprofloxacin (Cipro) AEs

A
  • CNS effects
  • tendon rupture
  • QT prolongation
  • phototoxicity
  • GI upset
52
Q

ciprofloxacin (Cipro) nursing considerations

A
  • educate on tendon injury and report early signs
  • utilize sunscreen and protective clothing
  • separate administration from dairy products by at least 6 hours before or two hours after
53
Q

metronidazole (Flagyl) MOA

A

after activation into active form, interacts with bacterial DNA to cause strand breakage and loss of helical structure that result in inhibition of nucleic acid synthesis and cell death

54
Q

metronidazole (Flagyl) indications

A

anaerobic bacteria infections (CDI, peptostreptococcus, eubacterium, and bacteroides); antiprotozoal coverage

55
Q

metronidazole (Flagyl) AEs

A
  • GI effects
  • HA, dry mouth, fatigue
  • neutropenia and thrombocytopenia
  • increases toxicities of lithium, benzos, cyclospoine, CCB, mood stabilizers, and warfarin
56
Q

metronidazole (Flagyl) nursing considerations

A
  • educate to not drink alcohol while on therapy (can cause disulfiram-like rxns)
  • monitor closely for drug interaction from altered metabolism
  • give with food to minimize GI upset
57
Q

daptomycin (Cubicin) MOA

A

causes efflux of intracellular potassium to depolarize the cell and inhibit synthesis of DNA, RNA, and protein to cause cell death

58
Q

daptomycin (Cubicin) indications

A

gram + bacterial infections only

59
Q

daptomycin (Cubicin) AEs

A
  • GI upset
  • myopathy
  • hypotension and hypertension
60
Q

daptomycin (Cubicin) nursing considerations

A
  • monitor for any new onset of muscle pain or weakness and baseline CPK
  • HGM-CoA reductase inhibitors (statins) may be stopped while taking daptomycin
  • monitor V/S closely (especially BP changes)
61
Q

isoniazid (INH) MOA

A

suppresses bacterial growth by inhibiting synthesis of mycolic acid (bactericidal to actively dividing bacteria and bacteriostatic to dormant bacteria)

62
Q

isoniazid (INH) indications

A

tuberculosis

63
Q

isoniazid (INH) AEs

A
  • hepatotoxicity
  • neuropathy
  • pyridoxine deficiency
  • optic neuritis and visual disturbances
64
Q

isoniazid (INH) nursing considerations

A
  • don’t take with antacids (decreased absorption)
  • educate and monitor for S/S of hepatitis
  • monitor liver enzymes and limit ETOH use
  • educate on S/S peripheral neuropathy (reversible with vitamin B6 prophylaxis)
  • report visual changes immediately
  • risk for non-adherence due to long term treatment duration
65
Q

rifampin (Rifandin) MOA

A

inhibits DNA-dependent RNA polymerase to suppress RNA synthesis and protein synthesis

66
Q

rifampin (Rifandin) indications

A
  • TB in combination with at least one other agent due to resistance
  • Leprosy
  • MAC (with ethambutol and macrolide)
67
Q

rifampin (Rifandin) AEs

A
  • hepatotoxicity
  • body fluid red-orange-brown discoloration
  • hematologic disorders
  • effects r/t accelerated metabolism of oral contraceptives, warfarin, PI, and NNRTI
68
Q

rifampin (Rifandin) nursing considerations

A
  • educate on and monitor for S/S hepatitis
  • monitor liver enzymes and CBC
  • education on fluid discoloration
  • child-bearing age females need additional BC
69
Q

pyrazinamide MOA

A

metabolized to pyrazinoic acid to lower pH, inhibits m. tuberculosis enzyme

70
Q

pyrazinamide indications

A

part of multi-drug regimen for active TB

71
Q

pyrazinamide AEs

A
  • hepatotoxicity
  • hyperuricemia (possible development of gouty arthritis)
  • GI upset
  • photosensitivity
72
Q

pyrazinamide nursing considerations

A
  • educate on and monitor for S/S hepatitis
  • monitor liver enzymes and serum uric acid levels
  • report any gout-like S/S (use NSAID PRN)
73
Q

ethambutol (Myambutol) MOA

A

promotes a bacteriostatic action by inhibiting arabinosyl transferase resulting in impaired mycobacterial cell wall synthesis

74
Q

ethambutol (Myambutol) indications

A

first-line agent used in combo theraoy for TB

75
Q

ethambutol (Myambutol) AEs

A
  • hepatotoxicity
  • GI tract disturbances
  • optic neuritis (blurred vision, constriction of visual field, disturbance of color discrimination)
76
Q

ethambutol (Myambutol) nursing considerations

A
  • educate and monitor for s/s of hepatitis
  • monitor liver enzymes
  • take w/ good to minimize GI upset
  • monitor for acute visual changes
77
Q

amphotericin B (Abelect) MOA

A

binds to components of fungal cell membrane to increase permeability, with resultant leakage leading to reduced viability

78
Q

amphotericin B (Abelect) indications

A

broad spectrum fungal coverage and often DOC for most systemic mycoses

79
Q

amphotericin B (Abelect) AEs

A
  • infusion reactions
  • dysrhythmias
  • nephrotoxicity and hypokalemia
  • neurotoxicity
80
Q

amphotericin B (Abelect) nursing considerations

A
  • minimize infusion reactions with antipyretics, antihistamines, antiemetics, and/or corticosteroids
  • monitor V/S closely
  • monitor heart rhythm on telemetry
  • monitor CMP, I/O, and kidney function
81
Q

itraconazole (Sporanox) MOA

A

inhibits synthesis of ergosterol to cause increased membrane permeability and cellular component leakage

82
Q

itraconazole (Sporanox) indications

A

broad spectrum fungal coverage for mycoses of esophageal, oropharyngeal, peritoneal, urinary tract, vaginal, and systemic candida

83
Q

itraconazole (Sporanox) AEs

A
  • GI upset most common
  • cardiac suppression
  • liver injury
84
Q

itraconazole (Sporanox) nursing considerations

A
  • assess medication use due to many possible drug interactions
  • admin with food to enhance medication absorption
  • monitor s/s of liver injury an heart failure
85
Q

nystatin MOA

A

binds to components of fungal cell membrane to increase permeability with resultant leakage leading to reduced viability

86
Q

nystatin indications

A

coverage similar to amphotericin B, but limited due to toxicity; mostly used for: oropharyngeal candidiasis prophylaxis in pts with neutropenia, treatment of oral and vaginal candidiasis

87
Q

nystatin AEs

A
  • GI upset most common with PO formulation
  • rash and urticaria with topical formulation
88
Q

nystatin nursing considerations

A
  • monitor PO route carefully with pediatric pts as it can be given via lozenge/troche
  • educate pts on proper administration with oral suspensions
89
Q

chloroquine MOA

A

concentrates heme in parasitized erythrocytes and interferes with metabolism and hemoglobin utilization by the parasite

90
Q

chloroquine indications

A

DOC for mild to moderate acute attacks caused by P. vivax and P. falciparum and prophylaxis of infection in erythrocytes

91
Q

chloroquine AEs

A
  • rare with prophylaxis low dose
  • GI upset
  • visual disturbances and headache
  • pruritis
92
Q

chloroquine nursing considerations

A
  • monitor pts with hepatic disease closely due to actions in liver
  • not able to prevent primary infection of liver
93
Q

Quinidine Gluconate MOA

A

concentrates heme in parasitized erythrocytes to produce lethal effect

94
Q

Quinidine Gluconate indications

A

IV therapy is DOC for severe malaria

95
Q

Quinidine Gluconate AEs

A
  • hypotension
  • acute circulatory failure
  • cardiotoxicity from bradycardia and hypokalemia/hypomagnesemia
96
Q

Quinidine Gluconate nursing considerations

A
  • slow IV admin after loading dose
  • monitor heart rhythm and BP frequently; slower admin if changes noted
  • monitor electrolytes (K and Mg)
  • co-admin with doxycycline, tetracycline, and clindamycin for effect enhancement

NURS 3303 (10 decks)

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