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Pharmacology > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Acyclovir

A 
MOA: Inhibits viral replication by suppressing DNA synthesis
Indications:
- Topical: HSV
- PO: HSV/VSV
- IV: HSH/VSV in immunocompromised patients
Adverse Effects:
- IV phlebitis
- Nephrotoxicity (increased BUN/creatinine)
- Neurotoxicity
Nursing Considerations:
- Monitor IV site 
- Monitor renal & neuro status
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2
Q

Ganciclovir

A

MOA: Inhibits viral replication by suppressing DNA synthesis
Indications:
- CMV in immunocompromised patients
Adverse Effects:
- Bone Marrow Suppression: thrombocytopenia/granulocytopenia
- Teratogenicity
Nursing Considerations:
- Monitor CBC for changes in WBC & PLT
- Co-adminsiter with granulocyte colony-stimulating factor (GCSF)
- PO with food
- Use of contraception

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3
Q

Interferon Alfa

A 
MOA: Interferes with...
- Viral entry
- Viral RNA & protein synthesis
- Viral assembly/release
Indications:
- Hepatitis B Virus
- Hepatitis C Virus
Adverse Effects:
- Flu-like s/s
- Severe depression
- Bone marrow suppression 
Nursing Considerations:
- Monitor liver s/s & enzymes
- Monitor mental status
- Monitor CBC
- Admin. acetaminophen for flu-like s/s
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4
Q

Ribavirin

A 
MOA: Increases interferon alfa effects
Indications:
- Hepatitis C treatment along with interferon alfa
Adverse Effects:
- Flu-like s/s
- Severe depression
- Bone marrow suppression 
- Hemolytic anemia
- Fetal injury!
Nursing Considerations:
- Monitor liver s/s & enzymes
- Extended contraception use (60 days after tx)
- Monitor mental status
- Monitor CBC
- Admin. acetaminophen for flu-like s/s
- Caution with sulfa allergies!
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5
Q

Simeprevir

A 
Protease Inhibitor 
MOA: Inhibits viral protease & replication
Indications:
- HCV
Adverse Effects:
- Headache, nausea, fatigue
- Hepatic injury
- Photosensitivity 
- Rash
Nursing Considerations:
- Monitor hepatitis s/s & liver enzymes
- Caution with sulfa allergies!
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6
Q

Daclatasvir

A 
NS5A Inhibitor
MOA: Inhibits NS5A protein which is necessary for viral replication and assembly
Indications:
- HCV
Adverse Effects:
- Headache & fatigue
- Possible anemia
Nursing Considerations:
- Monitor hepatitis s/s & liver enzymes
- Numerous drug interactions!
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7
Q

Oseltamivir

A

MOA: Inhibits neuraminidase to prevent viral replication and prevents newly formed viral particles from spreading to other cells
Indications:
- Influenza virus
Adverse Effects:
- Generally well-tolerated
- N/V
- Hypersensitivity & neuropsychiatric (rare)
Nursing Considerations:
- Rapid flu testing
- Tx should be started 48-72 after onset of symptoms
- Monitor for allergic reactions

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8
Q

Abacavir

A 
Nucleoside Reverse Transcriptase Inhibitor (NRTI)
MOA: Acts as a substrate for reverse transcriptase to inhibit replication & DNA synthesis
Indications:
- HIV
Adverse Effects:
- Lactic Acidosis
- Hepatic Steatosis
- Hypersensitivity
- Increase risk of MI
Nursing Considerations:
- Genetic Testing for hypersensitivity risk
- Monitor LA, HA, & MI s/s
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9
Q

Efavirenz

A

Non-Nucleoside Reverse Transcriptase Inhibitor
MOA: Binds to active center of reverse transcriptase to prevent replication & DNA synthesis
Indications:
- HIV
Adverse Effects:
- CNS s/s
- Rash
- Teratogenicity
Nursing Considerations:
- Numerous drug interactions
- Take on empty stomach to reduce CNS effects

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10
Q

Lopinavir/Ritonavir

A 
Protease Inhibitor
MOA: Inhibits protease, an enzyme needed for HIV maturation; ritonavir boosts lopinavir effects
Indications: 
- HIV
Adverse Effects:
- Diarrhea
- Hyperglycemia & new-onset diabetes
- Lipodystrophy & hyperlipidemia
- Prolonged PR & QT interval
Nursing Considerations:
- Cardiac monitoring (telemetry)
- Monitor glucose levels
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11
Q

Raltegravir

A 
Integrase Strand Transfer Inhibitor (INSTI)
MOA: inhibit integrase, an enzyme needed for HIV DNA insertion into host cell; prevents replication
Indications:
- HIV
Adverse Effects:
- Generally well-tolerated
- Elevated liver enzymes
- Hypersensitivity reactions
- Resistance more common
Nursing Considerations:
- Assess for hepatic injury & trend LFT
- Report skin manifestations & stop med immediately!
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12
Q

Enfuvirtide

A 
Fusion inhibitor
MOA: Inhibits HIV fusion into host cell; medication binds to lipid bilayer
Indications:
- HIV
Adverse Effects:
- SQ injection site reactions
- Bacterial pneumonia
- Hypersensitivity
Nursing Considerations:
- Administer SQ
- Monitor respiratory & integumentary s/s
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13
Q

Maraviroc

A

CCR5 Antagonist
MOA: Inhibits CCR5, a co-receptor needed for HIV entry into host cell
Indications:
- HIV
Adverse Effects:
- Hepatic Injury
- Increased risk for CV-events (MI, CVA, etc.)
Nursing Considerations:
- Assess for liver injury
- Assess CV status
- CCR5 tropism assay may be performed to ensure that HIV strain is compatible with this medication

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14
Q

Hydroxychloroquine

A 
Antimalarial & DMARD
MOA: may interfere with binding of SARS-CoV-2 spike protein to the host cell by reducing glycosylation of ACE2
Indications:
- SARS-CoV-2 FDA EUA (revoked June 2020)
Adverse Effects:
- Heart failure & cardiac dysrhythmias
- Neuropsychiatric effects (hallucinations, psychosis, agitation, etc.)
- Hemolytic anemia
- Severe hypoglycemia
- Skeletal muscle myopathy
- Retinal Damage
Nursing Considerations:
- Baseline exam prior to starting tx
- Baseline EKG
- Monitor cardiac s/s
- Monitor blood glucose
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15
Q

Remdesivir

A

IV SARS-CoV-2 Nucleotide Analog RNA Polymerase Inhibitor
MOA: Inhibits RNA polymerase; results in delayed chain termination during replication
Indications:
- COVID-19 infection requiring hospitalization
Adverse Effects:
- Elevated AST & ALT
- Hypersensitivity reactions (may be severe - anaphylaxis, etc.)
- Prolonged prothrombin time (PT)
Nursing Considerations:
- Monitor CMP & liver s/s
- Monitor renal function for impairment
- Discontinue infusion if hypersensitivity

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16
Q

Penicillin G

A

MOA: weakens the cell wall by targeting PBP’s & causing the bacterial cell to take up excess water and lyse
Indications:
- Gram-positive bacterial
- Strep, staph, enterococci, etc.
Adverse Effects:
- Allergy (cross-allergy with cephalosporins)
Nursing Considerations:
- Assess for hx of allergic rx
- Monitor infection status (CBC, VS, & s/s)
- Increased risk of C-diff infection (co-administer lactobacillus)

17
Q

Cephalosporin

A

MOA: weakens the cell wall by targeting PBP’s & causing the bacterial cell to take up excess water and lyse
Indications:
- As generations progress, more Gram-neg., anaerobic, and beta-lactamase resistance, and BBB selectivity.
Adverse Effects:
- Allergy (cross-allergy with penicillins)
- Disulfiram-like reaction with alcohol
Nursing Considerations:
- Assess for hx of allergic rx
- Monitor infection status (CBC, VS, & s/s)
- Increased risk of C-diff infection (co-administer lactobacillus)

18
Q

Piperacillin/Tazobactam

A

MOA: Penicillin-like MOA plus beta-lactamase inhibition through tazobactam
Indications:
- Gram-positive & negative
- Anaerobic coverage
Adverse Effects:
- Allergy!
Nursing Considerations:
- Assess for hx of allergic rx
- Monitor infection status (CBC, VS, & s/s)
- Increased risk of C-diff infection (co-administer lactobacillus)
- Monitor IV site (IV ONLY MED!)

19
Q

Imipenem/Cilastatin

A 
MOA: Binds specifically to PBP 1 & 2 to weaken cell wall & can resist beta-lactamases; cilastatin prevents rapid renal excretion
Indications:
- Very broad spectrum
- MRDO for bone, joint, SSTI, UTI, intraabdominal, and pelvic infx
Adverse Effects:
- Generally well-tolerated
- GI effects most common
- Superinfection
- Seizures
Nursing Considerations:
- Reserve for use in patients with infections NOT covered by other antibiotics
- Seizure precautions if needed
20
Q

Vancomycin

A

MOA: Weakens cell wall by binding to precursors of cell wall synthesis
Indications:
- Gram-positive for bone, joint, and blood infx
- MRSA & C-diff
Adverse Effects:
- Nephrotoxicity
- Ototoxicity
- Red-man syndrome (flushing, rash, pruritus, etc.)
Nursing Considerations:
- Monitor troughs (draw 30 mins before admin.)
- Monitor CMP for renal function
- Avoid use with other nephrotoxic drugs

21
Q

Doxycycline

A

MOA: bacteriostatic; binds to 30S ribosomal subunit to prevent binding of tRNA to mRNA which prevents addition of amino acids to growing peptide chain
Indications:
- Broad-spectrum coverage
- Rickettsial diseases, chlamydial diseases, Lyme disease, cholera, Mycobacterium pneumonia, anthrax, brucellosis, H. pylori, etc.
Adverse Effects:
- GI most common
- Bone growth suppression and teeth discoloration in children
- Alterations in normal flora (superinfection)
- Photosensitivity
Nursing Considerations:
- Decreased absorption with metal ions found in dairy products, laxatives, antacids, etc.
- Interacts with anticoagulants and oral contraceptives

22
Q

Azithromycin

A

Macrolide
MOA: bacteriostatic; binds to 50S ribosomal subunit to block addition of new amino acids to growing peptide chain
Indications:
- Most Gram-pos.; some Gram-neg.
- PCN alternative if allergic
- First line tx for pertussis, diphtheria, chlamydia, respiratory, GI, GU infx, & SSTI
Adverse Effects:
- GI most common
- QT prolongation
- Hepatotoxicity
- Ototoxicity
Nursing Considerations:
- Admin. PO on empty stomach except if GI upset
- Avoid in patients with pre-existing QT-prolongation; monitor on telemetry
- Can increase half-lives of several medications, especially theophylline & warfarin

23
Q

Clindamycin

A

Lincosamide
MOA: similar to macrocodes; bacteriostatic; binds to 50S ribosomal subunit to block addition of new amino acids to growing peptide chain
Indications:
- Gram-pos. & Gram-neg anaerobes
- Most Gram + aerobes
- Bone, GU, intraabdominal, pneumonia, septicemia, and SSTI.
- First line tx for severe strep group A and gangrene
Adverse Effects:
- Severe/fatal C-diff CDAD
- Non-C. diff Diarrhea
Nursing Considerations:
- Monitor for C-diff. s/s
- Excessive neuromuscular blockade & respiratory paralysis with concurrent use of NMBA
- Watch I/O & hypotension with IV infusions

24
Q

Linezolid

A 
Oxazolidinone 
MOA: Bacteriostatic; binds to 23S portion of 50S ribosomal subunit to block formation of initiation complex 
Indications:
- Very broad spectrum coverage, including MRDO
- VRE/MRSA
- CAP/HCAP
- Comp. & Uncomp. skin infections
Adverse Effects:
- Headache
- N/V/D
- Myelosuppression
- Neuropathy
Nursing Considerations:
- Monitor CBC & I/O
- Admin with food to limit GI upset
- Monitor for drug interactions with MAOi (HTN crisis) & SSRI (serotonin syndrome)
25
Q

Gentamicin

A

Aminoglycoside
MOA: Bacteriostatic & Bactericidal; binds to 30S ribosomal subunit to produce abnormal proteins which bind to cell wall & cause cell lysis
- Post-antibiotic effect which causes bactericidal effects to linger even when serum levels have decreases
Indications:
- Gram + cocci & aerobic Gram - bacilli
- E. coli, Klebsiella, & pseudomonas
- Used for SERIOUS INFECTIONS
Adverse Effects:
- Nephrotoxicity
- Ototoxicity
Nursing Considerations:
- Assess peak & troughs! (obtain 30 mins before/after admin)
- Assess UOP & CMP for renal function
- Assess hearing & balance (CN VIII)
- Increase fluid intake unless contraindicated

26
Q

Sulfamethazole/Trimethoprim

A

Sulfonamide/Folate Synthesis Inhibitor
MOA: bacteriostatic; inhibit tetrahydrofolate synthesis that is needed to make DNA, RNA, & proteins
Indications:
- Broad spectrum against Gram + and Gram -
- Commonly used for UTI, otitis media, bronchitis, shigellosis, and P. jiroveci
Adverse Effects:
- Stevens-Johnson’s & TENS (S-Sulfa/S-Stevens-J!)
- Blood dycrasias
- Megaloblastic anemia (RBC too large)
- Hyperkalemia
- Fetal damage
Nursing Considerations:
- Monitor for rash & stop immediately if present!
- Cross allergies with other sulfa-containing meds
- Monitor CBC & CMP

27
Q

Nitrofurantonin

A

MOA: unknown; thought to interfere with bacterial carbohydrate metabolism and disrupt cell wall formation
Indications:
- Broad spectrum against Gram + and Gram -
- Only used for tx & prophylaxis of acute lower UTI
Adverse Effects:
- GI effects most common
- Pulmonary reactions
- Various hematologic effects
Nursing Considerations:
- Not indicated for upper UTI!
- Educate patient on UTI prevention

28
Q

Ciprofloxacin

A

Fluoroquinolone “-floxacin”
MOA: Inhibits two enzymes needed for DNA replication & cell division
Indications:
- Broad spectrum against most aerobic Gram - & some Gram +
- Currently approved for infx of the respiratory tract, UTI, GI, bones, joints, & SSTI
Adverse Effects:
- Achilles tendon rupture!
- CNS effects
- QT prolongation
- Phototoxicity
- GI effects & C-diff infection
Nursing Considerations:
- Educate on tendon injury
- Utilize sunscreen & protective clothing
- Separate administration from dairy products

29
Q

Metronidazole

A

MOA: Once activated, interacts with bacterial DNA to cause strand breakage and loss of helical structure that results in inhibition of nucleic acid synthesis & cell death
Indications:
- Anaerobic bacterial infx, particularly C-diff
- Also covers peptostreptrococcus, eubacterium, and bacteroides
- Antiprotozoal coverage
Adverse Effects:
- GI effects
- Headache, dry mouth, & fatigue
- Neutropenia & thrombocytopenia
- Increases toxicities of lithium, benzos, cyclosporine, CCB, mood stabilizers, & warfarin (bleeding & profound hypotension)
Nursing Considerations:
- Do not drink alcohol (disulfiram-like reaction)
- Monitor closely for drug interactions from altered metabolism
- Give with food to minimize GI upset

30
Q

Daptomycin

A

MOA: Causes efflux of intracellular K+ to depolarize the cell & inhibit synthesis of DNA, RNA, & proteins, leading to cell death
Indications:
- Gram + only!
- MRSA & VRE
- Approved for S. aureus blood stream infx & SSTI
Adverse Effects:
- GI effects common
- Myopathy, especially if already on statin (can cause renal stress because of more things to filter)
- Hypotension/HTN
Nursing Considerations:
- Monitor for any new onset muscle pain or weakness
- Obtain baseline CK
Monitor VS closely

31
Q

Isoniazid

A

Primary agent for treatment and prophylaxis of TB
MOA: unclear; likely inhibits synthesis of mycelia acid, a component needed for mycobacterial cells walls
- Bactericidal to actively dividing bacteria; bacteriostatic to dormant bacteria
Adverse Effects:
- Hepatotoxicity
- Neuropathy
- Optic neuritis & visual disturbances
- Hyperglycemia
Nursing Considerations:
- Do not take with antacids due to decreased absorption
- Monitor for hepatitis s/s & liver enzymes! TEST QUESTION
- Neuropathy may be reversible with vitamin B6
- Report visual changes immediately!
- Risk for non-adherence due to long-term treatment duration

32
Q

Rifampin

A

Primary agent for treatment and prophylaxis of TB
MOA: Inhibits DNA-dependent RNA polymerase to suppress RNA and protein synthesis
Indications:
- DOC for TB in combination with at least one other agent due to resistance
- Leprosy (once a month dosing)
- MAC (with ethambutol & macrolide)
Adverse Effects:
- Hepatotoxicity
- Blood fluids turn red/orange/brown
- Hematologic disorders
- Effects r/t accelerated metabolism of oral contraceptives, warfarin, PI, and NNRTI
Nursing Considerations:
- Monitor for hepatitis s/s & liver enzymes!
- Education on fluid discoloration
- Child-bearing female patients need additional contraceptives!

33
Q

Pyrazinamide

A

First-line agent used in combo treatment for TB
MOA: unknown; possibly inhibits lipid and nucleic acid synthesis
Indications:
- Part of multi-drug regimen for ACTIVE TB
Adverse Effects:
- Hepatotoxicity
- Hyperuricemia (Gout-like syndrome)
Nursing Considerations:
- Monitor for hepatitis s/s & liver enzymes
- Monitor uric acid levels
- Report any gout-like s/s; use NSAID PRN

34
Q

Ethambutol

A

First-line agent used in combo treatment for TB; also used for MAC
MOA: Diffuses into mycobacterium and suppresses RNA synthesis to inhibit protein synthesis
Adverse Effects:
- Hepatotoxicity
- GI tract disturbances
- Optic neuritis
Nursing Considerations:
- Monitor for hepatitis s/s & liver enzymes
- Take with food to reduce GI upset
- Monitor for acute visual changes

35
Q

Amphotericin B

A 
MOA: binds to components of fungal cell membrane to increase permeability, with resulting leakage leading to reduced viability
Indications:
- Broad spectrum fungal coverage
- DOC for systemic mycoses
Adverse Effects:
- Infusion reactions
- Dysrhythmias
- Nephrotoxicity & hypokalemia
- Neurotoxicity
Nursing Considerations:
- Minimize infusion reactions with antipyretics, antihistamines, antiemetics, and/or corticosteroids
- Monitor VS closely (every 15 minutes)
- Monitor heart rhythm on telemetry
- Monitor CMP, I/O, & renal function
36
Q

Nystatin

A

MOA: binds to components of fungal cell membrane to increase permeability, with resulting leakage leading to reduced viability
Indications:
- Broad spectrum fungal coverage (limited due to toxicities)
- Used mostly for oropharyngeal candidiasis prophylaxis in patients with neutropenia
- Treatment of oral & vaginal candidiasis
Adverse Effects:
- GI most common
- Rash & urticaria
Nursing Considerations:
- Monitor PO route carefully with pediatric patients as it is often given via lozenge/troche
- Educate patients on proper administration with oral suspensions

37
Q

Fluconazole

A

MOA: inhibits synthesis of ergosterol to cause increased membrane permeability and cellular component leakage
Indications:
- Broad spectrum fungal coverage for mycoses of esophageal, oropharyngeal, peritoneal, urinary tract, vaginal, & systemic candida
- DOC for blastomycosis & sporotrichosis infections
Adverse Effects:
- GI most common
- Renal & liver injury
Nursing Considerations:
- Assess for BUN, creatinine, & liver enzymes
- Monitor I/O & UOP
- Assess for renal & liver injury s/s

38
Q

Chloroquine

A

MOA: Concentrates heme in parasitized erythrocytes to produce lethal effect
Indications:
- Mild-moderate acute attacks caused by P. vivid & P. falciparum and prophylaxis of infection in erythrocytes
Adverse Effects:
- Rare with prophylactic low dose
- GI effects
- Visual disturbances
Nursing Considerations:
- Monitor patients with hepatic disease closely
- Not able to prevent primary infection of the liver

39
Q

Quinidine Gluconate

A

MOA: Concentrates heme in parasitized erythrocytes to produce lethal effect
Indications:
- IV tx is DOC for severe malaria
Adverse Effects:
- Hypotension
- Acute circulatory failure
Nursing Considerations:
- Slow IV administration
- Monitor heart rhythm and BP frequently; slower administration if changes noted
- Watch for wide QRS complexes & prolonged QT intervals
- Monitor electrolytes, particularly K+ & Mg

Pharmacology (6 decks)

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