Antimicrobials Flashcards
Acyclovir
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
Ganciclovir
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
Interferon Alfa
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
Ribavirin
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!
Simeprevir
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!
Daclatasvir
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!
Oseltamivir
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
Abacavir
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
Efavirenz
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
Lopinavir/Ritonavir
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
Raltegravir
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!
Enfuvirtide
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
Maraviroc
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
Hydroxychloroquine
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
Remdesivir
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
Penicillin G
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)
Cephalosporin
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)
Piperacillin/Tazobactam
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!)
Imipenem/Cilastatin
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
Vancomycin
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
Doxycycline
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
Azithromycin
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
Clindamycin
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
Linezolid
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)
Gentamicin
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
Sulfamethazole/Trimethoprim
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
Nitrofurantonin
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
Ciprofloxacin
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
Metronidazole
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
Daptomycin
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
Isoniazid
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
Rifampin
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!
Pyrazinamide
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
Ethambutol
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
Amphotericin B
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
Nystatin
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
Fluconazole
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
Chloroquine
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
Quinidine Gluconate
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
