Ch 39 Antibiotics Part 2 Flashcards
What are the different known multidrug-resistant organisms?
- MRSA
- VRE
- ESBL and KPC-producing organisms
Where is MRSA found?
In hospitals and Community
In what type of infection is VRE often seen?
Urinary Tract Infection
In the 4 drug-resistant organisms, which ones are the most difficult to treat?
ESBL and KPC- producing organisms –> are resistant to ALL beta-lactam antibiotics.
- Can be treated only w/ Carbapenems + Quinolones
What is the property of Aminoglycosides?
Bactericidal = which makes Aminoglycosides the drug of choice when treating particularly virulent infections.
What is “Therapeutic drug monitoring” and why is it used w/ Aminoglycosides treatment?
The dosages are adjusted to maintain known optimal levels that maximize drug efficacy and minimize the risk for toxicity.
2 risks are closely monitored when taking Aminoglycosides, what are they?
1) Nephrotoxicity
2) Ototoxicity
- Monitor creatinine levels
What is necessary for the Aminoglycosides to be efficient?
The serum level should be at least 8 times higher than the MIC (minimum inhibitory concentration).
What particular type of bacteria are Aminoglycosides indicated for?
- Gram negative
- some Gram +
- Aminoglycosides are never used alone to treat Gram positive infections.
What type of patients should the nurse use caution when administering Aminoglycosides?
Pre-mature and full-term neonates because renal immaturity.
What serious pediatric infections should be treated with Aminoglycosides?
- Pneumonia
- Meningitis
- UTIs
What is a very important contraindication if using Aminoglycosides?
Pregnancy –> irreversible bilateral congenital deafness in fetus
What are the most common adverse effects of Aminoglycosides?
- 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
What 2 interactions or undesirable effects occur when taking Aminoglycosides?
- kill intestinal bacterial flora
- ⬇ amount of vitamin K
What are the main nursing assessments when administering Aminoglycosides?
- 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
What is an important nursing implementation when giving Aminoglycosides?
Fluids of up to 3000 mL/day should be encouraged.
What are the 3 main properties of Quinolones (= Fluoroquinolones)?
1) Bactericidal antibiotic
2) Broad spectrum
3) Wide variety of gram + and -
What are the indications of Quinolones?
- Complicated UTIs
- Respiratory, skin, GI, bone and joints infections
- STDs
What is a contraindication in the use of Quinolones?
Children = although used for Cystic Fibrosis
What are the most common adverse effects of Quinolones?
- 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.
What is an important nursing implementation when delivering Quinolones?
Must be infused over 1 to 1.5 hours.
What are the 4 known interactions w/ Quinolones?
- Antacids
- Iron
- Zinc preparations
- Sucralfate
- -> greatly reduce absorption of Quinolones
*Caution w/ anticoagulants and caffeine
What are the main nursing assessments when administering Quinolones?
- Seizure/ stroke disorders
- Bowel activity
- Neuromuscular = dizziness, headache, visual changes
- I & O
- Blood glucose
When should the Quinolones be administered?
2 hours AFTER meals
- Other drugs should not be given within 2 hours of the quinolones to avoid the many drug interactions.
