Antimicrobials Flashcards
1
Q
Name Beta-lactam antibiotics
A
amoxicillin/clavulanate
piperacillin/tazobactam
2
Q
Beta-lactam inhibitors?
A
clavulanate
sulbactam
tazobactam
3
Q
name Beta-lactam antibiotic (abx) classes
A
penicillin
cephalosporins
carbapenems
monobactams
4
Q
Name Penicillin (PCN)
A
- amoxicillin
- amoxicillin/clavulanate (for kids/keep refrigerated)
- Penicillin G
- piperacillin/tazobactam
5
Q
Name Indications for Penicillins
A
- Sites: skin, soft tissue, pulmonary (i.e. cellulitis, sinusitis, pneumonia).
- Coverage primary Gram positive
6
Q
What are side effects from Penicillins?
A
- Itching, rash
2. Angioedema
7
Q
What are the precautions for Penicillins?
A
- Cephalosporin allergy
- Highest allergy response among antibiotics
- Many drug interactions
8
Q
Contraindications for Penicillins
A
Cephalosporin allergy
9
Q
Nursing actions for Penicillins
A
High alert if giving with cephalosporin allergy
10
Q
Indications for Cephalosporins
A
- Sites: skin, soft tissue, pulmonary, genitourinary (GU).
- Microbes covered change across the generations
a. 1st generation: primarily gram +, susceptible to Beta-lactam as
b. 2nd generation: intermediate coversge-gram +, and gram -, more Beta-lactam as resistance
c. 3rd/4th generation: primarily gram -, ^duration of action, good celebrospinal fluid penetration (meningitis )
11
Q
side effects of cephalosporins
A
- Acute alcohol intolerance. (disulfiram-like reaction ). Antabuse (disulfiram) effect during TX and for approximately 3 days after (give to someone who wants to abstain from alcohol. Mouthwash w/alcohol will make you sick )
- antibiotic associated colitis (AA colitis) (
12
Q
precautions for Cephalosporins
A
PCN(Penicillins ) allergy
13
Q
Contraindications for Cephalosporins
A
PCN (Penicillins ) allergy
14
Q
Nursing Actions with Cephalosporins
A
High alert if giving with PCN (Penicillins ) allergy
15
Q
Examples of Cephalosporins
first generation
A
- cephalexin
- cefazolin (sergical, one dose in 1hr before the surgery )
16
Q
examples of Cephalosporins
second generation
A
a. oral: cefaclor (kids otitis media)
17
Q
examples of Cephalosporins
third generation
A
ceftriaxone
(for head stuff (meningitis ), pneumonia gram -
18
Q
examples of Cephalosporins fourth generation
A
cefepime
gram -
can be sustituted with ceftriaxone (cephalosporins third generation )
19
Q
Indications for Macrolides
A
- Sites: skin, soft tissue, pulmonary, gastrointestinal, ears, GU (genitourinary )(some STD’s)
- Covers primarily gram+, spirochetes (syphilis, Lyme disease), STD(sexual transmitted diseases–N. gonorrhea, Chlamydia), H. Pylori
- GI stimulant (for decrease motility, usually only if unresponsive to other treatments )
20
Q
Side effects for Macrolides
A
- Extreme GI effects
2. AA colitis (inflammatory response in colon)
21
Q
Precautions for Macrolides
A
- Many drug interactions (death/drug interactions )
- Cardiac dysrhythmias, QT prolongation(a heart rhythm disorder that can potentially cause fast, chaotic heartbeats)
- Concurrent use: drugs that compete “hepaticly” (CYP–450)/protein bound
22
Q
Contraindications for Microlides
A
Concurrent use with some antihistamines and antifungal agents.
23
Q
Nursing Actions with Microlides
A
- Ensure reason for use–antimicrobial vs. gastrointestinal stimulant (to stimulate GI tract, give low dose on Microlides then for antimicrobials)
- Patient education –GI effects by class.
24
Q
examples of Microlides
A
- fidaxomicin (c-diff)
- Erythromycin (GI tract
25
Indications for Fluoroquinolones
1. Broad spectrum:
primarily gram -, some gram +
2. Urinary tract infections (UTI), prostatis,
anthrax, sinusitis, bronchitis, community acquired pneumonia (CAP), acute otitis externa (drops)(for swimmers ears), ocular
26
Side effects for Fluoroquinolones
1. Cardiac dysrhythmias
2. Nausea, constipation; photosensitivity
3. Tendonitis/ tendon rupture--Black Box
(do not want to use them for simple infections because of this horrible side effects )
27
Precautions for Fluoroquinolones
1. Cardiac dysrhythmias
| 2. Renal disease; seizure disorder
28
Contraindications for Fluoroquinolones
1. Concurrent use of class IA and III abtydysrhythmic agents (procainamide, amiodarone)
2. Use in children (oral route)
29
Nursing Actions for Fluoroquinolones
Follow renal function, cardiac rhythm; muscle/tendon pain
30
examples of Fluoroquinolones
- ciprofloxacin
| - levofloxacin
31
Indications for Sulfonamides
1. Broad spectrum: gram +, gram - organisms
2. UTI, otitis media (OM), upper respiratory infections, some STD's
Pneumocystis caring pneumonia (PCP)--now: Pneumocystis jirovecii pneumonia
skin, soft tissue
32
Side effects for Sulfonamides
1. Allergy reactions common --fever, rash (sulfa base-- problem for sulfa allergy )
2. Pacytopenia; blood dyscrasias; liver and renal dysfunction
3. Photosensitivity; Stevens-Johnson Syndrome (skin ref, blistering, peeling off)
33
Precautions for Sulfonamides
1. Liver and renal disease
| 2. Many drug interactions
34
Contraindications for Sulfonamides
Sensitivity to sulfa based drugs--thiazide and loop diuretics (hydrochlorothiazide, metozalone, furosemide); sulfonylureas, etc
35
Nursing Actions for Sulfonamides
Follow CBC, LFTs(liver), BUN/Cr (renal )
| -look at labs (bone marrow supression)
36
examples of Sulfonamides
sulfamethoxazole/trimethoprim
37
Indications for Aminoglycosides
1. More serious /life threatening infections--gram -, some gram +
2. Often used in combination with other antimicrobial Agents
get sinergestic affect, works good w/other med
less toxic to person, but kills the bug
38
Side effects for Aminoglycosides
1. Nephrotoxicity--changes in BUN/Cr, urine output (kidney will go out w/ghis drug (look to iron output) Peak-Trough
2. Ototoxicity--dizziness, tinnitus (ringing in ears, not reversible), hearing loss
39
Precautions for Aminoglycosides
Liver/renal dysfunction
40
Contraindications for Aminoglycosides
Pregnant and lactating women --unless life threatening infection
41
Nursing Actions for Aminoglycosides
1. Follow CBC, LFTs (liver), BUN/Cr (renal)
| 2. Ensure peak and trough drug levels done appropriately
42
examples of Aminoglycosides
- amikacin
- gentamicin
- tobramycin
43
Indications for Tetracycline
1. Very broad spectrum; many resistance issues
| 2. Acne, H. Pylori, Ricketts is (Rocky Mountain Spotted Fever ), some STDs
44
Side effects for Tetracycline
1. GI: diarrhea, AA colitis;
hepatotoxicity(^possibility of colitis )
2. Photosensitivity
3. Many drug interactions
4. May discolor teeth (children)(binds to
calcium), (no diary 2-3 hrs till dose)
45
Precautions for Tetracycline
1. Binds calcium, magnesium, aluminium
| 2. Nomilk/diary /antacids/ironwithin 2-3 hours of dose
46
Contraindications for Tetracycline
1. Children <8 years old (affect on bone
development)
2. Pregnant and lactating women
47
Nursing Actions for Tetracycline
Patient education: no diary products within 2-3 hours of dose
48
examples of drugs in Tetracycline
Tetracycline
49
Indications for Antifungal agents
1. Susceptible fungal organism--Candida,
Coccidioides, Aspergillus
2. Multiple sites of infection : oral, esophagus, skin, pulmonary, vaginal, systemic.
50
Side effects for Antifungal agents
1. Headaches, nausea, vomiting, liver/renal
dysfunction /toxicity
2. Amphotericin B: fever, shivering, renal/neuro toxicity, cardiac dysrhythmias
51
Precautions for Antifungal agents
1. Renal or liver impairment
| 2. Many drug interactions
52
Contraindications for Antifungal agents
Liver failure
53
Nursing Actions for Antifungal agents
1. Follow LFTs, BUN / Cr
| 2. Ensure appropriate premedication as indicated (amphotericin B)
54
examples of Antifungal agents
- fluconazole
- amphotericin B(lots side effects(follow Creatinine), premedicate, will cause fever (give acetaminophen)
- nystatin
- ketoconazole(inter. w/Macrolides class)
55
Indications for metronidazole
1. Susceptible protozoa /anaerobic organisms
2. First line therapy for c. difficile (give oral)
3. Prophylaxis and treatment in colorevtzl and gyn surfery/infection (GI because of anaerobic coverage w/GI)
56
Side effects for metronidazole
1. Headache, dizziness, liver dysfunction
2. Antabuse (disulfiram )effect, metallic taste
3. Neutropenia, thrombocytopenia
57
Precautions for metronidazole
1. Liver or renal dysfunction, fungal infection
| 2. Multiple drug interactions
58
Contraindications for metronidazole
Pregnancy, first trimester (Category X)
59
Nursing Actions for metronidazole
1. Follow LFTs, BUN /Cr
| 2. C. difficile: stoolC/ S, infection control
60
Indications for vancomycin
vancomycin --glycopeptide (alternate w/c. diff)
1. Serious /life threatening Gram + illness
2. Bloodstream, bone
3. Methicillin resistant staphylococcus aureus
(MRSA)
4. Alternate treatment for c. difficile --oral
61
Side effects for vancomycin
1. Nephrotoxicity and otoxicity
| 2. Red man syndrome
62
Precautions for Vancomycin
Renal dysfunction /failure (follow trough and adjust based on trough)
63
Nursing Actions for vancomycin
1. Follow BUN /Cr
| 2. Trough drug levels; peak levels controversial
64
Indications for clindamycin
clindamycin --lincosemide
anaerobic coverage, weired drug, colitis
1. Serious infection, Gram positive and some
anaerobic organisms
2. Abdomen /GI, gyn, soft tisdue, pneumonia (susceptible and anaerobic)
65
Side effects for clindamycin
1. down WBC, rash, shortness of breath
| 2. Pseudo membranous and AA colitis
66
Precautions for clindamycin
1. Liver, renal dysfunction
| 2. Hx AA colitis
67
Contraindications for clindamycin
1. Ulcerative colitis
| 2. Astma
68
Nursing actions for clindamycin
Follow LFTs, renal function
69
Indications for Antituberculosis/antimicrobial agents
1. Prophylaxis with exposure to tuberculosis
(TB)
2. Treatment of active TB
70
Side effects for Antituberculosis /antimycobacterial agents
1. Hepatitis; liver toxicity; nephrotoxicity (renal)
| 2. Pyridoxine (Vitamin B6)deficiency--INH: peripheral neuropathy (must have this vitamin while giving drug.
71
Precautions for Antituberculosis /antimycobacterial agents
Liver or renal disease
72
Contraindications for Antituberculosis /antimycobacterial agents
Acute/major liver or renal disease
73
Nursing Actions for Antituberculosis /antimycobacterial agents
1. Diagnosis: sputum testing for acid fast bacilli
(AFB). C/S guides drug combination used.
2. LFTs, hepatitis profile
3. CBC, BUN /Cr
4. Ensure patient taking Meds
Direct Observation Treatment (DOT)
5. Proper referrals--Health Department, family treatment, etc.
74
examples of drugs in class Antituberculosis /antimycobacterial agents
1. izoniazid
a. Prophylaxis with exposure, and treatment
of active TB
b. Supplement with pyridoxine (Vitamin B6)-
prophylaxis
2. rifampin
a. take on employ stomach; turns all body
fluids red/orange (urin, sweat, tears...)
b. may be used with other infections, based
on C/S.
3. pyrazinamide
Contraindicated in severe hepatic disease,
acute gout
4. ethambutol
a. Contraindicated in children <13 years
b. May be used with other infections, based on C/S.
75
Indications for HUV/AIDS agents
1. Exposure to human immunodeficiency virus
(HIV)
2. Infection with human immunodeficiency virus
(HIV)
3. Diagnosis of acquired immune deficiency
syndrome (AIDS)
4. Goals: viral load <50 copies/ml blood
CD4>200cells/mm3=HIV, CD4 <200=AIDS
no opportunistic infections
76
Side effects for HIV /AIDS agents
1. Nausea/vomiting /diarrhea
2. Bone marrow suppression; osteoporosis
3. Protease inhibitors --diabetes, dyslipidemia
77
Precautions for HIV /AIDS agents
1. Concurrent infection with Hepatitis C,
tuberculosis
2. Multiple drug interactions
78
Contraindications for HIV /AIDS agents
Known severe drug allergy or intolerable side effects
79
Nursing Actions for HIV /AIDS agents
1. Follow viral load and CD4 counts
2. Monitor for side effects
3. Monitor for opprtunistic infections
80
Examples of drugs in classes HIV /AIDS agents
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1. Reverse transcripts inhibitors (RTI)--inhibits
DNA synthesis
a. Nucleoside (NTRI)
-zidovudine
b. Non nucleoside (NNRTI)
-efavirenz
2. Protease inhibitors (PI)--inhibits protease
retrovirus enzyme
-ritonavir
3. Fusion / entry inhibitors -- inhibits HIV fusion
to the host CD4 T lymphocyte.
-enfuvirtide
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