CH 46 to 50: Antibiotics for Bacterial Infections Flashcards
Actions of Antibiotic (Abx) Drugs
- affect target organism’s structure, metabolism, or life cycle
- goal = eliminate pathogen
- may be used for prophylactic treatment of people with suppressed or compromised immune systems
Abx: bactericidal vs bacteriostatic?
Bactericidal = kill bacteria
bacteriostatic = slow growth of bacteria
Abx: Nursing Considerations
- make sure pt finishes all abx
- don’t share
- keep away from children (safety lid + lock)
- educate about abx decreasing effects of oral contraceptives and use back up BC – will decr efficacy of hormone-based BC
- teach pts to wear medic-alert bracelets if allergic
how long to observe pt for possible allergic reactions after parental admin?
observe for 30 mins, esp after first dose
- monitor for hypersensitivity
- make sure pt knows s/s of allergic rxn
Abx nursing considerations: food
- teach when to take w/ food & when to avoid certain foods (i.e., Ca/iron - tetras)
- take probiotics (1-2x/day) to counter antibiotic
- replacement of normal colon flora w/ probiotic supplements or cultured dairy products
- most best taken on empty stomach
What SEs of Abx to look for?
- skin, teeth, tendons, ears, kidneys
- assess renal + hepatic function (esp in elderly) = 2.2lb or 1kg/day
How to choose abx + how long?
look @ location + shape
- bony locations = harder for abx to get to, e.g., sinus infection = 10-14 days; ear infections ~5 days
Role of Penicilins - Nurse’s job
- assess previous drug rxn to penicilin (animal products exposed to abx)
- avoid cephalosporins if pt has severe penicilin allergy
- monitor for hyperkalemia + hypernatremia (incr risk in pt w/ DM/ on dialysis)
- monitor cardiac status, including ECG changes
Cephalosporin Therapy: Role of Nurse
- assess presence/hx of bleeding disorders
- assess renal + hepatic function (esp in elderly)
- assess for persistent diarrhea in children
- avoid alcohol
Why assess for presence/hx of bleeding disorders when taking cephalosporin abx?
- can reduce prothrombin levels through interference w/ vitamin K metabolism
why avoid alcohol when taking cephalosporins?
some cephalosporins cause disulfiram (Antabuse)-like reaction with alcohol – will start to severely vomit
Tetracyline Therapy: Nursing Considerations
- **decr **effectiveness of OCP - should use alt BC
- incr potential for yeast infection while taking OCP + tetracyclines
- caution w/ impaired liver/kidney function
- take on empty stomach to incr absorption
- may result in photosensitivity
- watch for supra infection, e.g., pseudomembranous colitis
- don’t take w/ milk products, iron supplements, magnesium-containing laxatives, or antacids (fluoros)
Macrolide Therapy: Nurse’s Role
- watch liver (EES) erythromycin estolate
- multiple drug-drug interactions w/ macrolides (CYP)
- examine pt for hx of cardiac disorders - may exacerbate existing heart disease
- cause metallic taste in mouth
toxicity? SEs? last name?
Aminoglycosides
- more toxic than most abxs
- have potential for serious AEs
- last names don’t work with this family and macrolides
Adverse effects of aminoglycosides
- ototoxicity, worse if given with lasix
- nephrotoxicity, worse if given with Zovirax (acyclovir)
- neuromuscular blockage, including resp paralysis
what are they for? how do they work?
Fluoroquinolines
- initially for UTIs
- bacteriocidal, affect DNA synthesis by inhibting 2 bacterial enzymes
- activity against gram-neg pathogens, newer drugs have activity against gram-positive microbes
- for infections of GI, GU, resp, skin + soft tissues
- “-oxain’s”
Fluoroquinolines - route, food + others
- decr 90% if taken with multivitamins or minerals such as Ca, Mag, Fe, Zinc ions (Tetras 50%)
- IV = PO, easy transition to home
- can cause C. Diff, dysrhythmias + liver failure (QT prolongation + arrythmias)
- CNS disturbances affect 1-8% of pts
Who can’t you give fluoroquinolones?
- Cipro, teenagers or atheletes, will cause tendon rupture
- children + lactacting or pregnant women
- crosses into breast milk
Which fluoroquinolone can cause photophobia?
norfloxacin – sensitivity to lights
Sulfonamides - what are they + why are they used?
- bacteriostatic, inhibit folic acid
- broad spectrum, but widespread use has led to incr resistance
- used in combination to treat UTIs
- anti-inflammatory properties can help w/ RA + UC
- teratogenic - cause birth defects
- don’t take when breastfeeding or pregnant
Sulfonamides - Abx allergy?
Rxn to sulfonamide abx could mean allergy to other sulfonamide meds
- DM sulfonylyreas (glyburide + glimepiride), NSAIDs (celecoxib), certain “h2o pills” (furosemide, chlorothiazide), IBD (sulfasalazine)
- allergy to those meds may cause sensitivity to abx, caution w/ 1st dose
Sulfonamides: Prototype drug
trimethoprim-sulfamethoxazole = tmp/smz
- bactrim, septra, cotrimoxazole
- potential for allergic rxn
Trimethoprim-sulfamethoxazole: mechanism of action
Sulfonamides
to kill bacteria by inhibiting metabolism of folic acid
Trimethoprim-sulfamethoxazole: Adverse Effects
- skin rashes
- N/V
- agranulocytosis or thrombocytopenia (caution w/ pernicious anemia)
- photosensitivity
