Ch 39 Antibiotics Part 2

Question 1

What are the different known multidrug-resistant organisms?

Answer 1

• MRSA
• VRE
• ESBL and KPC-producing organisms

Question 2

Where is MRSA found?

Answer 2

In hospitals and Community

Question 3

In what type of infection is VRE often seen?

Answer 3

Urinary Tract Infection

Question 4

In the 4 drug-resistant organisms, which ones are the most difficult to treat?

Answer 4

ESBL and KPC- producing organisms –> are resistant to ALL beta-lactam antibiotics.

• Can be treated only w/ Carbapenems + Quinolones

Question 5

What is the property of Aminoglycosides?

Answer 5

Bactericidal = which makes Aminoglycosides the drug of choice when treating particularly virulent infections.

Question 6

What is “Therapeutic drug monitoring” and why is it used w/ Aminoglycosides treatment?

Answer 6

The dosages are adjusted to maintain known optimal levels that maximize drug efficacy and minimize the risk for toxicity.

Question 7

2 risks are closely monitored when taking Aminoglycosides, what are they?

Answer 7

1) Nephrotoxicity
2) Ototoxicity

• Monitor creatinine levels

Question 8

What is necessary for the Aminoglycosides to be efficient?

Answer 8

The serum level should be at least 8 times higher than the MIC (minimum inhibitory concentration).

Question 9

What particular type of bacteria are Aminoglycosides indicated for?

Answer 9

• Gram negative
• some Gram +
• Aminoglycosides are never used alone to treat Gram positive infections.

Question 10

What type of patients should the nurse use caution when administering Aminoglycosides?

Answer 10

Pre-mature and full-term neonates because renal immaturity.

Question 11

What serious pediatric infections should be treated with Aminoglycosides?

Answer 11

• Pneumonia
• Meningitis
• UTIs

Question 13

What is a very important contraindication if using Aminoglycosides?

Answer 13

Pregnancy –> irreversible bilateral congenital deafness in fetus

Question 14

What are the most common adverse effects of Aminoglycosides?

Answer 14

• Nephrotoxicity (⬆ risk if on loop diuretics)
• Ototoxicity (dizziness, tinnitus, sense of fullness in the ears and hearing loss)
• Proteinuria

Less common = headache, paresthesia, vertigo, skin rash and fever

Question 15

What 2 interactions or undesirable effects occur when taking Aminoglycosides?

Answer 15

• kill intestinal bacterial flora

- ⬇ amount of vitamin K

Question 16

What are the main nursing assessments when administering Aminoglycosides?

Answer 16

• Hypersensitivity
• OTC drugs –> many drug interactions/contraindications
• S x S of ototoxicity and nephrotoxicity
• BUN level
• Urinalysis
• Serum + urine creatinine levels
• Neuromuscular assessment
• Hydration status

Question 17

What is an important nursing implementation when giving Aminoglycosides?

Answer 17

Fluids of up to 3000 mL/day should be encouraged.

Question 18

What are the 3 main properties of Quinolones (= Fluoroquinolones)?

Answer 18

1) Bactericidal antibiotic
2) Broad spectrum
3) Wide variety of gram + and -

Question 19

What are the indications of Quinolones?

Answer 19

• Complicated UTIs
• Respiratory, skin, GI, bone and joints infections
• STDs

Question 20

What is a contraindication in the use of Quinolones?

Answer 20

Children = although used for Cystic Fibrosis

Question 21

What are the most common adverse effects of Quinolones?

Answer 21

• Bacterial overgrowth
• Cardiac dysrhythmias
• ⬆ AST + ALT levels
• Oral candidiasis
• Dysphagia
• Nausea, constipation, diarrhea
• FDA Black Box Warning = Tendonitis and tendon rupture
• Common effect in elderly, patients in renal failure and those receiving concurrent glucocorticoid therapy.

Question 22

What is an important nursing implementation when delivering Quinolones?

Answer 22

Must be infused over 1 to 1.5 hours.

Question 23

What are the 4 known interactions w/ Quinolones?

Answer 23

• Antacids
• Iron
• Zinc preparations
• Sucralfate
• -> greatly reduce absorption of Quinolones

*Caution w/ anticoagulants and caffeine

Question 24

What are the main nursing assessments when administering Quinolones?

Answer 24

• Seizure/ stroke disorders
• Bowel activity
• Neuromuscular = dizziness, headache, visual changes
• I & O
• Blood glucose

Question 25

When should the Quinolones be administered?

Answer 25

2 hours AFTER meals

• Other drugs should not be given within 2 hours of the quinolones to avoid the many drug interactions.

Question 27

What should the nurse assess when administering Vancomycin (Miscellaneous Antibiotics)?

Answer 27

• Nephrotoxicity
• Ototoxicity
• Patient’s skin = Red Man syndrome

Question 28

How should the reconstituted solutions of Clindamycin be handled (Miscellaneous Antibiotics)?

Answer 28

Kept at room temperature. Never refrigerate because of thickening.

Question 29

What is a teaching tip to communicate to the patient when taking Metronidazole (Miscellaneous Antibiotics)?

Answer 29

The urine may turn red-brown or darker in color.

Question 30

What is a teaching tip to communicate to the patient when taking Nitrofurantoin (Miscellaneous Antibiotics)?

Answer 30

The urine can turn dark yellow or brown

• Also know to report alopecia, numbness and tingling of extremities.

Question 31

In general, Antibiotics are never to be administered via which route?

Answer 31

Enteral IV push

Question 31

What are the different Miscellaneous Antibiotics?

Answer 31

1) Clindamycin
2) Linezolid –> treat diabetic foot, VRE, HAIs
3) Metronidazole
4) Nitrofurantoin
5) Quinupristin/dalfopristin
6) Vancomycin
7) Daptomycin
8) Colistimethate

Question 31

What are the indications for Aminoglycosides besides pediatric indications?

Answer 31

Prophylaxis that can be experienced by patients who are:

1) High risk for enterococcal infections (during GI tract procedures)
2) Undergoing surgery and have a history of valvular heart disease