antimicrobials pt 1 Flashcards
bacteria
single-celled organisms that lack a nucleus
viruses
nonliving particles that reproduce by taking over living cells
fungi
single organisms including mushrooms and yeast that grow as single cells or thread like filaments
protozoa
single celled organism with nucleus
Bacteriostatic
suppresses organisms growth
bactericidal
directly destroys organism
post antibiotic effect
*organisms do not grow for several hours even after discontinuation of medication
selective toxicity
ability of medications to affect target organisms only without harming host cells
narrow spectrum
active against only a few species of microorganisms
broad spectrum
- active against a wide variety of microorganisms
Empiric therapy
therapy started in absence of laboratory data
minimum inhibitory concentration
lab measure of lowest drug concentration needed to prevent growth of certain bacteria
peak
measurement of highest drug concentrations
trough
measurement of lowest drug concentrations
Penicillin G (benzylpenicillin) MOA
weakens bacterial cell wall
Penicillin G (benzylpenicillin) indications
infections caused by gram positive bacteria (step, enterococcus, staph)
Penicillin G (benzylpenicillin) adverse effects
allergic reactions but usually well tolerated
Penicillin G (benzylpenicillin) nursing considerations
asses for hx of allergic reactions; possibly also allgeric to cephalosporins
-monitor CBC, vitals and infection s/s
-C-diff infections in possible, co admin with lactobacillus
immediate penicillin allergies
reaction in 2-30 minutes
accelerated penicillin allergy
reaction in 1-72 hours
delayed penicillin allergy
reaction takes days or weeks to develop
Treatment PCN Anaphylaxis
stop med, administer epi, and provide respiratory support
piperacillin/tazobactam (zosyn) MOA
PCN action + inhibits bacterial beta-lactamase with tazobactam
piperacillin/tazobactam (zosyn) indications
Extended spectrum (PCN susceptible organisms plus gram - and anaerobic coverage, including pseudomonas, enterobacter, Klebsiella)
piperacillin/tazobactam (zosyn) adverse effects
Low toxicity
Allergic reactions
piperacillin/tazobactam (zosyn) nursing considerations
same as pcn g
parenteral route only
monitor IV site and compatibility with other IV meds
Cephalosporins MOA
inhibit cell wall synthesis
cefazolin (ancef) indications
surgical prophylaxis
Cefepime (Maxipime)
resistant organisms
Ceftaroline (Teflaro)
skin infections and HCAP
Cephalosporins adverse effects
allergic reactions
bleeding due to interefence with vitamin K
disulfiram-like reactions with alcohol
Cephalosporins nursing considerations
monitor vitals, CBC, s/s of infection
c-diff possible
if allergic to PCN, prob allergic to cephalosporin
Imipenem/Cilastatin (Primaxin) MOA
weaken cell wall and can resist beta-lactamases
Imipenem/Cilastatin (Primaxin) indications
broad spectrum with activity against most pathogens
for bone, joint, SSTI, UTI, intraabdominal and pelvic infections
Imipenem/Cilastatin (Primaxin) adverse effects
GI effects most common (NVD)
seizures with renal impairement
superinfections
Imipenem/Cilastatin (Primaxin) nursing considerations
admin with cilastatin to prevent rapid imipenem breakdown in kidneys
seizure precaution
Vancomycin (Vancocin) MOA
weakens cell wall
Vancomycin (Vancocin) indications
gram positive coverage for bone, joint, and bloodstream infections
MRSA and C diff
Vancomycin (Vancocin) adverse effects
○Nephrotoxicity leading to renal failure
○Ototoxicity
○Red man syndrome
○VRE
Vancomycin (Vancocin) nursing cosiderations
usually IV, PO for C-Diff
monitor trough levels and CMP for kidney function
avoid concurrent use with nephrotoxic meds
C-DIff percautions
Doxycycline MOA
inhibits protein synthesis
Doxycycline indications
broad spectrum coverage against many gram postive and negative
Doxycycline adverse effects
GI most common
Bone growth suppression and teeth discoloration in peds
fatty liver infiltration and worsens renal impairment
alterations in normal flora and superinfections
photosensitivity
Doxycycline nursing considerations
decreased absorption when given with Ca, Fe, and Mg, admin on empty stomach
hepatic and renal monitoring
avoid prolonged sunlight exposure
interacts with oral contraceptives and anticoag
Erythromycin MOA
inhibits protein synthesis
Erythromycin indications
most gram positive and some gram neg coverage
Erythromycin adverse effects
GI most common including epigastric pain
QT prolongation
hepatotoxicity and ototoxicity
numerous med interactions
Erythromycin nursing considerations
1st alt to PCN sensitivity
admin PO on empty stomach to max absorption
avoid in pt with pre-exisiting QT prolongation
can increase half life of several meds
Clindamycin (Cleocin) MOA
inhibits protein synthesis
Clindamycin (Cleocin) indications
gram positive and neg
anaerobes and most gram positive aerobes
Clindamycin (Cleocin) adverse effect
sever- fatal C diff, ab pain, fever, leukocytosis
non Cdiff diarrhea
Clindamycin (Cleocin) nursing considerations
monitor stool and fluid status
vigorous fluid and electrolyte replacement w/ vanc treatment
Linezolid (Zyvox) MOA
inhibits protein synthesis
Linezolid (Zyvox) indications
very broad spectrum
Linezolid (Zyvox) adverse effects
headache NVD
myelosuppression (anemia, leukopenia, thrombocytopenia, pancytopenia)
optic and peripheral neuropathy
Linezolid (Zyvox) nursing considerations
-Monitor CBC and I/O
-Give with food to limit GI upset
-Monitor for drug interactions with MAO (hypertensive crisis) and SSRI (serotonin syndrome)
Gentamicin MOA
Protein synthesis inhibitor
Gentamicin indications
primarily used for serious infections
Gentamicin adverse effetcs
nephrotoxicity due to proximal renal tube injury
ototoxicity impairing both hearing balance
Gentamicin nursing considerations
assess serum peak and trough
neruo focused assessment
increase fluid intake unless contraindicated
dont mix with PCN
Sulfamethoxazole/Trimethoprim (Bactrim) MOA
bacteriostatic
inhibits synthesis of DNA, RNA, and protein
Sulfamethoxazole/Trimethoprim (Bactrim) indications
broad spectrum against gram positive and gram neg
Sulfamethoxazole/Trimethoprim (Bactrim) adverse effects
○Sulfonamide AE
■Photo- & hypersensitivity reactions, including SJS/TENS
■Hemolytic anemia
■Kernicterus in newborns
■Renal damage from crystalline aggregates
○Trimethoprim AE
■Megaloblastic anemia
■Hyperkalemia
Sulfamethoxazole/Trimethoprim (Bactrim) nursing cosniderations
monitor for rash and stop immediately if present
cross allergies w/ sulfa meds
monitor CBC and CMP and progression of infection
Nitrofurantoin (Macrobid) MOA
causes bacterial injury by inhibiting DNA, RNA, and protein synthesis and energy metabolism
Nitrofurantoin (Macrobid) indications
● Broad spectrum against gram + and gram -
○Currently only used for treatment and prophylaxis acute lower UTI
Nitrofurantoin (Macrobid) adverse effects
GI most common
pulmonary reactions (dyspnea, cough, malaise)
hematologic effects
Nitrofurantoin (Macrobid) nursing considerations
- not indicated for upper UTI
- encourage increased water intake and cranberry juice and avoid other potential nephrotoxic drugs
Ciprofloxacin (Cipro) MOA
inhibit DNA replaication/cell division
Ciprofloxacin (Cipro) indications
braod spectrum against most aerobic gram -, some gram +
Ciprofloxacin (Cipro) adverse effects
CNS effects
Tendon rupture, achilles
QT prolongation
Phototoxicity
GI effects
Ciprofloxacin (Cipro) nursing considerations
edu on tendon inury
suncreen
separate admin from dairy products, at least 6 hrs before or 2 hrs after
Metronidazole (Flagyl) MOA
DNA strand breakage and loss of structure which causes inhibition of nucleic acid synthesis and cell death
Metronidazole (Flagyl) inidcations
anaerobic bacteria infections (CDI)
peptostreptococcus
eubacterium
bacteriudes
antiprotozoal coverage
Metronidazole (Flagyl) adverse effects
○GI effects
○HA, dry mouth, & fatigue
○Neutropenia and thrombocytopenia
○Increases toxicities of lithium, benzos, cyclosporine, CCB, mood stabilizers, and warfarin
Metronidazole (Flagyl) nursing cosniderations
○Educate not to drink alcohol while on therapy; can cause disulfiram-like reactions
○Monitor closely for drug interactions from altered metabolism
○Give with food to minimize GI upset
Daptomycin (Cubicin) MOA
inhibit synthesis of DNA, RNA, and protein to cause cell death
Daptomycin (Cubicin) indications
gram + bacterial infections only
Daptomycin (Cubicin) adverse effects
○GI effects common
○Myopathy, especially if already on statin
○Hypotension and hypertension
Daptomycin (Cubicin) nursing cosniderations
monitor new onset muscle pain/weakness and baseline CPK
○HGM-CoA reductase inhibitors (statins) may be stopped while on daptomycin
monitor Vitals
Isoniazid (INH) MOA
suppress bacterial growth by inhibits the synthesis of mycolic acid
Isoniazid (INH) indications
TB
Isoniazid (INH) adverse effects
HEPTATOXICITY
neuropathy
pyridoxine deficiency
optic neuritis and visual disturbances
Isoniazid (INH) nursing considerations
taking with antacids causes decreased absorption
educate on monitoring for s/s of hepatitis
monitor liver enzymes and limit alcohol
educate on s/s of peripheral neuropathy (may be reversible with vitamin B6 prophylaxis)
risk for non-adherence
Rifampin (Rifandin) MOA
suppress RNA synthesis and protein synthesis
Rifampin (Rifandin) indications
TB in combination with at least one other agent
leprosy (1/month)
MAC ( with ehtabutol and macrolide)
Rifampin (Rifandin) adverse effects
HEPATOTOXICITY
body fluid red/organe/brown
hematologic disorders
deactivates oral contraceptives, warfarin, PI, & NNRTI
Rifampin (Rifandin) nursing considerations
educate on & monitor s/s hepatitis
monitor liver enzymes and CBC
educate on fluid discoloration
child-bearing women need additional birth control
Pyrazinamide MOA
Inhibits m. tuberculosis enzyme
Pyrazinamide indications
multi-drug regimen for active TB
Pyrazinamide adverse effects
HEPATOTOXICITY
hyperuricemia
GI disturbances (NVD)
photosensitivity
Pyrazinamide nursing considerations
educate on/monitor s/s hepatitis
monitor liver enzymes and serum uric acid
report any gout like s/s
use NSAIDs PRN
Ethambutol (Myambutol) MOA
promotes bacteriostatic action which impaires mycobacterial cell wall synthesis
Ethambutol (Myambutol) indications
combo therapy for TB
MAC
Ethambutol (Myambutol) adverse effects
Hepatotoxicity
GI tract disturbances
Optic neuritis, resulting in blurred vision, constriction of visual field, and disturbance of color discrimination
Amphotericin B (Abelect ) MOA
binds to fungal cell membrane to reduce viability
Amphotericin B (Abelect ) indications
broad spectrum fungal coverage
Amphotericin B (Abelect ) adverse effects
infusion rx
dysrhythmias
nephrotoxicity and hypokalemia
neurotoxicity
Amphotericin B (Abelect ) nursing considerations
Minimize infusion reaction with antipyretics, antihistamines, antiemetics, and/or corticosteroids
Monitor VS closely
Every 15 minutes
Monitor heart rhythm on telemetry
Monitor CMP, I/O, kidney function
Itraconazole (Sporanox) MOA
inhibits synthesis of ergosterol to cause cellular leakage
Itraconazole (Sporanox) indications
broad spectrum fungal coverage
Itraconazole (Sporanox) adverse effects
GI effects most common
cardiac suppression
liver injury
Itraconazole (Sporanox) nursing considerations
Assess medication use due to possible drug interactions
Administer with food to enhance absorption
Monitor s/s liver injury and heart failure
Nystatin MOA
binds to fungal cell to reduce viability
Nystatin indications
broad spectrum fungal coverage but limited use due to toxicity
used mainly for oropharyngeal candidiasis prevention and treat of oral and vaginal candidiasis
Nystatin adverse effects
GI most common with PO
rash and urticaria with topical
Nystatin nursing considerations
watch Po route carefully with kids
educate on proper administration with oral suspensions
Chloroquine MOA
interferes with metabolism and hemoglobin utilization by parasite
Chloroquine indications
mild to moderate acute attacks of P. vivax and P.falciparum
prophylaxis for erythrocytes
Chloroquine advers effects
rare with prophylacyic low dose
GI effects/ab discomfort
visual disturbances and headache
pruritis
Chloroquine nursing considerations
watch pts with hepatic disease closely
not able to prevent primary infection of liver
quinidine gluconate MOA
concentrates heme in parasitized erythrocytes to produce lethal effect
quinidine gluconate indication
IV therapy for severe malaria
quinidine gluconate adverse effects
hypotension
acute circulatory failure
cardiotoxicity from bradycardia and hypokalemia/hypomagnesemia
quinidine gluconate nursing considerations
slow Iv admin after loading dose
watch heart rhythm and BP frequently
watch electrolytes (K and Mg)
co-admin with doxycycline, tetracycline, or clindamycin for enhancement
