Ch. 29, Ch. 30, Ch. 31

Question 1

Major Classifications:

Answer 1

1. ) Penicillins = antibiotic
2. ) Cephalosporins = antibiotic
3. ) Macrolides
4. ) Tetracyclines
5. ) Aminoglycosides
6. ) Fluoroquinolones

Question 2

Also Classified:

Answer 2

• Bacteriostatic

* Bactericidal

Question 3

Bacteriostatic (1):

Answer 3

• Inhibit growth of bacteria 

- Allows body’s immune system to complete the job of destroying organism

Question 4

Bacteriostatic (2):

Answer 4

• Bacteriostatic drugs preferred: 
  
  • Minor infections
  • Healthy client

Question 5

Bactericidal (1):

Answer 5

-Killing action:

Ex: penicillins & cephalosporins

Question 6

Bactericidal (2):

Answer 6

Bactericidal drugs preferred:

 * Serious, life-threatening infection
 * Poor immune system

Question 7

May Have a Narrow Therapeutic Index:

Answer 7

• Monitor:

* Peak & trough levels

Question 8

Mechanism of Action (1):

Answer 8

1. ) Inhibit cell wall synthesis = 

* Loss of structural integrity of cell & death of organism

Question 9

Mechanism of Action (2)

Answer 9

2. ) Alter membrane permeability

* Permits leakage of intracellular components = death of microorganism (bacterialsidal)

Question 10

Mechanism of Action (3):

Answer 10

3.) Inhibit protein synthesis (bacterialstatic)

Interferes with protein formation in bacterial cell –>

Prevents normal growth & reproduction

Easier for body’s immune system

Question 11

Mechanism of Action (4):

Answer 11

4. ) & 5.) Antimetabolites:

* Blocks / alters specific metabolic functions needed for growth &/or functioning (either bacterialstatic/cidal)

Question 12

Resistance to Antibacterials:

Answer 12

Sensitive = pathogen inhibited or destroyed

Resistant = pathogen continues to grow

Question 13

Acquired Resistance:

Answer 13

d/t prior exposure to antibiotic

 * i.e. Staphylococcus aureus 
 * Repeated exposure to drug  microorganisms evolves to become resistant

Question 14

Antibiotic Therapy:

Answer 14

1. ) Take med ‘around the clock’
   - Over 24 hour period
2. ) Finish all of medication –>
   - To get rid of lingering bacteria so organism does not develop resistance

Question 15

General (3 major) Adverse Reactions to Antibacterials:

Answer 15

1. ) Allergic (hypersensitivity)
2. ) Superinfection
3. ) Organ toxicity

Question 16

1.) Hypersensitivity

Answer 16

Allergic reaction =

*Rash, urticaria, fever, moist respirations, bronchospasms, anaphylaxis

Question 17

Hypersensitivity cont…

Answer 17

• Reaction does not occur with first exposure

* Discontinue drug

Question 18

Cross - Sensitivity:

Answer 18

Client who is hypersensitive to one classification of antibiotic may develop a similar reaction with a drug in the same or related chemical class

Question 19

2.) Superinfection

Answer 19

Secondary infection when normal flora of the body is disturbed:
*Ex: mouth ulcers, vaginal infection, diarrhea

Question 20

Superinfection cont….

Answer 20

Teach client:

 * Report s/s 
 * Buttermilk or yogurt

Question 21

3.) Organ Toxicity

Answer 21

High doses over a prolonged period of time = organ toxicity
-Liver, kidneys

Most common toxicity = irritation of GI tract

Question 22

(Antibiotic) Broad Spectrum (1):

Answer 22

Acts on variety of different organisms

Disrupts both pathogenic & useful microorganisms

Good = identity of causative agent not identified

Question 23

Broad Spectrum (2):

Answer 23

Disadvantage =

• Destroys body’s normal microbes –>
• May develop diarrhea & allow superinfection to occur

Question 24

Narrow Spectrum (1):

Answer 24

• Selective

* Useful: Infections caused by limited number of organisms

Question 25

Narrow Spectrum (2):

Answer 25

Good = identity of causative organism IS KNOWN

Not as likely to disrupt normal flora

May be safer than broad spectrum

Question 26

Penicillins (pcn) (1):

Answer 26

Most are bactericidal =

 - Inhibit synthesis of bacterial cell wall * Narrow spectrum * Broad spectrum

Question 27

Penicillins (2):

Answer 27

Oral therapy:

* Good for mild – mod infections
* Take on empty stomach (1 hr before a meal or 2 hrs after)

Question 28

Penicillins (3):

Answer 28

Parenteral therapy:

  * Severe infections
  * Produces rapid & higher pcn blood levels than po

Question 29

Beta-Lactamase (enzyme) Inhibitors:

Answer 29

Broad-spectrum antibiotic + beta-lactamase inhibitor –>

Antibiotic inhibits bacterial betalactamase –>

More effective & extends antimicrobial effect (EX: augmentin (to help make better)

Question 30

Examples of Penicillins:

Answer 30

penicillin G
penicillin V
amoxicillin 
ampicillin
nafcillin
Carbenicillin (IV USE)
Ticarcillin (IV USE)

Question 31

Nursing Process (1):

Answer 31

1. ) Check for allergic reaction to pcn

2. ) Especially after 1st or 2nd doses

Question 32

Teach:

Answer 32

1. ) Medical alert bracelet or tag (if allergic to PCN)
2. ) Encourage fluid intake
3. ) Take with food to avoid gastric irritation

Question 33

Evaluate:

Answer 33

1. ) Efectiveness of drug

2. ) Monitor for Side Effects

Question 34

Cephalosporins (1):

Answer 34

1. ) Chemically & pharmacologically r/t (related) pcn

2. ) Act by inhibiting cell wall synthesis

Question 35

Cephalosporins (2):

Answer 35

3.) 4 groups (generations)

4. ) Each generation differs re:
   
   • Spectrum of antimicrobial activity

5.) Most are IM/IV

Question 36

Cephalosporins (3):

Answer 36

(Similar to PCN):

*Clients who are allergic to pcn may also be allergic to cephalosporins

Question 37

Cephalosporins (4):

Answer 37

Side Effects:

* GI disturbances
* Alt in blood clotting	
* Nephrotoxicity

Question 38

Cephalosporins (5):

Answer 38

Drug interactions:

-With alcohol  flushing, dizziness, n/v, muscle cramps

Question 39

Examples (po):

Answer 39

cephalexin (Keflex)
cefadroxil (Duricef)
cefaclor (Ceclor)

Question 40

Examples (IM/IV):

Answer 40

cefoperazone (Cefobid)
ceftriaxone (Rocephin)
cefuroxime (Zinacef)

Question 41

Nursing Process (2):

Answer 41

Infuse IV cephalosporins over 30-45min to prevent pain & irritation

Question 42

Nursing Process

Answer 42

Before starting ANY antibiotic therapy =

*Send sample to lab for culture & sensitivity (C&S) [if ordered]