ch. 26 - penicillins, other beta-lactams, and cephalosporins & ch. 28 - tetracyclines and doxycyclines

Question 1

ability of a microorganism previously sensitive to a drug to withstand its effects

• the bacteria continues growing despite taking the antibiotic (this is bad = antibiotic resistance)

Answer 1

acquired bacterial resistance

Question 2

• Obtain blood sample within an hour AFTER the infusion has completed (45-60 mins)
• If this level is high = toxicity

Answer 2

peak levels

Question 3

• Obtain blood sample minutes before the next dose is to be administered (usually after the 3rd dose)
• If trough is low = patient is not getting enough to kill the bacteria

Answer 3

trough levels

Question 4

• test BEFORE you administer the first dose of antibiotic
• Culture: identifies the organism causing the infection
• Sensitivity: Determines which antibiotic the organism is sensitive to

Answer 4

culture & sensitivity (C&S)

Question 5

secondary infection that occurs when the normal microbial flora of the body are disturbed (fungal infections)

Answer 5

superinfection

Question 6

Primarily effective against 1 type of organism (selective)

Answer 6

narrow spectrum antibiotics

Question 7

• Can be effective against gram positive and gram-negative organisms
• May be prescribed initially to treat infections until the C&S test results then the drug can be changed if needed

Answer 7

broad spectrum antibiotics

Question 8

Class: Glycopeptide

• Can be given IV to treat c.diff, MRSA, and other serious infections that don’t respond to more mild antibiotics
• When given via IV, always make sure your IV site is patent. Assess throughout infusion for any signs of reactions. We will give this over 1-2 hours. Dosing will be based on kidney function by the pharmacist

Answer 8

vancomycin

Question 9

red man syndrome!!!

• do NOT freak out (its just a reddening of the skin)
• just slow IV infusion rate
• nephrotoxicity and ototoxicity (can result in hearing loss)

Answer 9

side effects of vancomycin

Question 10

-Assess for allergy to PCN or cephalosporin antibiotics
-Assess your labs for kidney and liver function
-Get C&S test before starting therapy
-Monitor closely if the patient has never had a PCN drug for any reaction
-Assess for superinfection and treat promptly
-Have epi available in case a reaction occurs
-Monitor for signs of improving infection
-Take entire prescribed therapy to avoid antibiotic resistance
-Increase fluids (water)
-Use a back-up form of birth control
-Take with food to decrease GI distress
—Someone who is allergic to PCN is at risk for being allergic to a cephalosporin medication. Cephalosporin medications included on table 26.6 p.321 (a very common cephalosporin we administer is ceftriaxone also known as rocephin)

If you have to mix up the antibiotic yourself, make sure the fluid you mix it in is compatible

Answer 10

penicillin in general

Question 11

• Beta lactam antibiotic (just means this medication’s structure interferes with bacterial growth)
• Broad spectrum PCNs will treat gram+ and gram
  excreted via kidneys= -must assess renal function first (BUN and creatinine)! Lower dose for older adult

Answer 11

penicillin

Question 12

• Superinfection
• Hypersensitivity
• GI distress

Answer 12

side effects of penicillin

Question 13

Class: penicillin (broad spectrum)

• Contraindicated if you have an allergy to any PCN
• Can be used to treat a variety of infections

Answer 13

amoxicillin

Question 14

• GI distress, rash, tongue and tooth discoloration, superinfection, prolonged bleeding time
• We need to ask if the patient is allergic to a cephalosporin such as ceftriaxone

Monitor renal function

Answer 14

side effects of amoxicillin

Question 15

• Structurally and functionally similar to penicillins
• Broad-spectrum antibiotics that can be used by most patients that are allergic to penicillin
• There are 5 groups or generations
• 10% of people allergic to PCN are allergic to this class due to having similar drug properties (assess for allergies before giving first dose)
• If you drink with this class à disulfiram like reaction
• Obtain C&S before first dose
• Monitor for superinfection
• Assess renal function closely
• Continue taking medication even if you feel better
• Take with food if GI upset occurs

Maintain adequate hydration

Answer 15

cephalosporin antibiotics in general

Question 16

GI distress, increased bleeding risk, nephrotoxicity (toxic to the kidneys), c.diff infection

• reaction to alcohol

Answer 16

side effects of cephalosporin

Question 17

Class: Cephalosporin

• Treats a variety of infections
• Contraindicated with renal impairment, hypersensitivity to other cephalosporins - caution use if allergic to PCN
• Get culture first then administer antibiotic
• Assess for allergies

Answer 17

ceftriaxone

Question 18

• bleeding, superinfection, nephrotoxicity, & GI upset
• If you hang this IVPB you must make sure your primary fluids are compatible. We cannot use lactated ringers with this medication.
• Report severe diarrhea
• Report any signs of allergic reaction

Answer 18

monitor w/ ceftriaxone

Question 19

Class: antibiotic (broad spectrum)

• This class ends in “cline”- Tetracycline
• Obtain C&S first
• Major interactions: milk and foods high in calcium slow absorption (take on empty stomach with full glass of water 1 hour before meals or 2 hours after meals/milk)
• Oral contraceptives are lessened à back up birth control
• Assess liver and kidney function
• Children under 8 and pregnant women need to avoid this class
• Medication can discolor teeth

Basic education: take full course of treatment as prescribed, discard expired medication because it can be toxic, wear sunblock and protective clothing
Maintain effective oral hygiene, DO NOT TAKE WITH DAIRY

Answer 19

tetracyclines

Question 20

photosensitivity (sunburn reaction), GI upset, teratogenic!!!!, nephrotoxicity, superinfection

Answer 20

side effects of tetracyclines

Question 21

Class: Tetracycline

Obtain C&S first
- Major s/e: photosensitivity (sunburn reaction), GI upset, teratogenic!!!! nephrotoxicity, superinfection
- Major interactions: milk and foods high in calcium slow absorption.

Unlike other tetracycline drugs this particular one has increased absorption with food. so encouraged to take with food

Answer 21

doxycyclines

Question 22

mild (rash/hives/pruritus) or severe (anaphylactic shock)

Answer 22

allergy or hypersensitivity

Question 23

Toxicity to the ears, often drug induced and manifesting as varying degrees of hearing loss that is likely to be permanent.

Answer 23

ototoxicity