Chapter 38 39 40 42 exam 1 Flashcards
antibiotics taken before exposure to an infectious organism in an effort to prevent the development of infection
prophylactic
this class of antibiotics may cause tooth discoloration in children under age 8
teracycline
anaphylactic reactions are coon with this class of antibiotics
penicilin
antibiotics that kill bacteria
bactericidal
there is a chance of cross-reactivity between this class of antibiotics and the class in PCN
cephalosporin
the classification for the drug erythomycin
macrolide
this class of antibiotics is commonly used in urinary tract infections
sulfonamide
antibiotics that inhibit the growth of bacteria
bacteriostatic
an infection that occurs during antimicrobial treatment for another infection and involves overgrowth of a nonsusceptible organism
superinfection
antimicrobials are used to treat ____ infection.
bacterial
We use antibiotics to significantly _____ morbidity and mortality from ____ infection
reduce, bacterial
Antibiotics treat ___
bacterial infections
Antiviral treat __-
virus
broad spectrum antibiotics kill: ____ and ___
broad range and normal flora bacteria
Bacteriocidal antibiotics kill the
bacteria
bacteriostatic do what:
slow the bacterial growth
___ allows the host defense mechanisms to take over and kill the bacteria
bacteriostatic
Patient with Pseudomembranous Colitis having a watery diarrhea with >10-20 stools/day, what does that indicate?
Nothing, Normal. If >5 stools/day notify prescriber
In a sign of infection, what test should a nurse do before anything else?
Culture
What type of Antibiotics should be given to the patient during the 72 hours of culture sensitivity testing?
Broad spectrum
What is the normal WBC count?
5000-10000
What indicates a high WBC count?
Systemic Infection
What indicates a low WBC count?
Blood infection, cancer.
What type of patients are more susceptible to drug fever?
Elderly & AIDS pt.s
A life threatening superinfection caused by c. diff?
Pseudomembranous Colitis
Patient with Pseudomembranous Colitis having a watery diarrhea with >10-20 stools/day, what does that indicate?
Notify Physician
What is the cause of fungal overgrowth?
When Antibiotic kills all of the bacteria susceptible to the drug, the normal flora bacteria that keeps fungi in check.
What bacteria example has B-lactamase enzyme in it?
streptococcus pneumoniae
Vancomycin is a drug of choice for what type of infection?
MRSA
If Vancomycin is infused quickly, what could be one of the effect of it?
Red man/red neck syndrome
The main use of sulfonamides today is for ____
UTI
Tetracycline should not be taken with ____
Antacids, dairy
What routes can PCN G be administered?
IM or IV
4 mechanisms for acquired resistance
- spontaneous bacterial mutation
- conjugation of bacteria
- To much exposure to broad spectrum
- large amounts of antibiotics used in livestock
what is critical when getting a clean catch UA
patient teaching about catching the urine after the flow has started
what does empiric therapy/treatment treat
presumptive cause of the infection
in empiric therapy/treatment when do we start giving the antibiotic?
before we have sensitivity results back or know exactly what the bacteria is.
what is important about identifying the infecting organism
so we can match the drug with the bug
when do you do a Culture and sensitivity test?
before any antibiotic is given.
You are given the following orders; what should you do first for a patient with pneumonia?
- chest x-ray
- administer pain medication
- get a clean catch urine
- culture and sensitivity test
- culture and sensitivity test because you cant do the xray you have to call for that. You do not have her pain level for the pain meds the clean catch urine is nice but not the most important you need the c&S so you can know what antibiotics your pt. needs
lab results are what? ____ _____
patient specific
2 reasons getting a gram stain report is important
- tells if the bacteria will be sensitive to the antibiotic
- it guids the choice of antibiotic until the sensitivity results are back
in order for antibiotics to work they must be ____ and ____
at the site of infection
and
for sufficient time
patient teaching regarding the duration of antibiotics should focus on
taking the medication fully so that the patient does not build up a resistance
what is potentiative and antagonistic given to treat a bacterial infection
used together but given at different times
why do we give antibiotic combinations
for more than one bacteria
Two examples that we do potentiative and antagonistic to help the prevention of resistance
Tb, H pylori
what is prophylactic use of antimicrobial definition
agents given to prevent infection rather than to treat an estalished infection
3 ways we use prophylactic antimicrobials
- pre-op surgery
- bacterial endocarditis
- neurtropenic pts.
attempted treatment of untreatable infections leads to :
resistance
how do we monitor antimicrobial therapy
- we check for clinical indicators of success
- serum drug levels for toxicity
- retest for laboratory results
- frequency of monitoriing should increase or decrease depending on the severity of the infection
What is drug fever
fever that can be the sole manifestation of an adverse drug reaction
If your patient suddenly develops a fever what do you need to do
rule out other causes of infection
what is the only treatment for drug fever
removal of the offending drug rather than adding to it
drug fever can be two types of reactions .. they are:
- hypersensitivity/allergic response
2. non allergic reaction
what is the common cause of drug fevers
antibiotics
who is most likely to get a drug fever
elderly and aids patients
risk of developing drug fever ___ with the number of drugs prescribed
increases
what happens in supra/superinfectons
the normal flora bacteria that keeps fungi in check is gone resulting in fungal overgrowth
are supra/super infections bacterial, viral or fungus?
fungus
what is pseudomembranous colitis
life threatening superinfection caused by clostridium difficile
When do you notify the prescriber if your patient has profuse watery diarrhea
when > 5 stools a day
You should suspect ____ if your patient has abd pain, fever, high wbc, and distinct smel
C. Diff
What is the drug to treat C. Diff
Metronidazole (flagyl) or if severe PO Vanco
Your patient requests antidiarrheal meds while he has c diff what do you educate him about
that the anitdiarrheal meds will compound the problem that his body needs to rid itself of the bacteria causing the infection
You are administering an antibiotic when you notice a diffuse maculopapular rash all over the back of your pt. what do you think the next steps will involve
notify the doctor, expect to d/c the antibiotic, benadryl may be prescribed, watch for anaphylactis
What is the drug to treat strep pneumonia?
Penicillin
Mycoplasma pneumoniae and Haemophilus influenzae (H.Flue) are both bacterias. What can they cause?
atypical pneumonia and lots of URIs (Upper resp infections)
How long must you monitor pts when starting penicillin?
Monitor pt taking penicillin for an allergic reaction for at least 30 minutes after administration
What can make penicillin go inactive?
Bacteria produce enzymes known as beta lactamases capable of destroying penicillin
What bacteria has a b lactamase enzyme?
Strep pneumo
Penicillin weakens the __ __ causing __ to take up excessive water and rupture?
cell wall; bacteria
How is Zosyn used?
IV only and used for pseudomonas
Piperacillin/tazobactam is another word for?
Zosyn
What do beta-lactmase inhibitors (subclass of PCN) do?
adds a substance to stop the beta lactam enzyme
What are some beta-lactamase inhibitors ?
Ampicillin/sulbactam (Unasyn)
Amoxicillin/clavulanic acid (Augmentin)
Piperacillin/tazobactum (Zosyn)
Another word for Amoxicillin/clavulanic acid?
Augmentin
Another word for Ampicillin/sulbactam?
Unasyn
What are some beta-lactam PCNs?
- amoxicillin
- pencillin G
Amoxicillin (Amoxil) is a?
broad-spectrum beta lactam penicillin
Amoxicilin is effective against?
gram positive bacteria
Adverse effects of amoxicillin?
- diarrhea: antibiotic associated diarrhea not caused by C is very common
- rash
Amoxil can disrupt the normal gut flora to your pt. what should you teach them?
Teach the pt to eat yogurt (probiotics) to replenish normal flora
What are the % rates to penicillin allergy?
- About 5% rate of allergic response to pcn most common cause of drug allergies.
- 10% of pcn allergic pts are allergic to cephalosporins also.
Anaphylaxis S/S of pcn?
- severe hypotension
- laryngeal edema
- bronchoconstriction
Anaphylaxis tx of pcn?
epinephrine dose
What should the nurse ask the pt who will be receiving pcn and why?
Need to ask if they are allergic to pcn, what type of reaction they will have, side effects, because that can develop an allergic response at any time.
What route of administration would you give a 1% concentration of epinephrine solution?
Oral inhaltion
What route of administration would you give a 0.1% concentration of epinephrine solution?
- Subcutaneous
- Intramuscular
- Intraspinal
What route of administration would you give a 0.01% concentration of epinephrine solution?
- Intravenous
- Intracardiac
What route of administration would you give a 0.001% concentration of epinephrine solution?
In combination with local anesthetics
Vancomycin can cause what if infused too quickly?
Red man/Red neck syndrome
Vancomycin is the treatment choose for?
MRSA (Methicillin-resistant Staphylococcus aureus)
What must you monitor when a pt is on vancomycin?
- Must monitor blood levels to ensure therapeutic levels and prevent toxicity
- Must monitor trough levels
Vancomycin should be infused over how many minutes otherwise what?
60 minutes; rapid infusions may cause hypotension
Inflammation and clot due to trauma of vein?
Thrombophlebitis
Thrombophlebitis is?
Inflammation and clot due to trauma of vein
Tetracycline is best on a?
empty stomach
Tetracyline can cause an esophageal infection, how can you prevent this?
When taking Tetracycline, always drink with a FULL glass of water (6-8oz)
What must you watch for when using tetracycline?
- epigastric discomfort
- diarrhea
- heartburn
- photosensitivity
Tetracycline is a broad spectrum. What do you use it for?
chlamydia-syphilis-gonorrhea
What should be avoided when taking tetracycline?
Avoid milk products, iron preparations, antacids, and other dairy products because of chelation and drug-binding that occurs
Causes the most c. diff of all antibx
Clindamycin
Causes the urine to turn brown/orangy color
Nitrofurantion
What are Nitrofurantoin only used for?
treat and prevent UTI
What are some side effects of sulfa?
Stevens-Johnson syndrome, toxic epidermal necrosis, photosensitivity, and hemolytic anemia.
Drugs which are extensively metabolized through the what?
CyP450 liver enzyme system
CyP450 has what?
lots of drugs interactions
DI’s means?
Drug interactions
Tetracycline
prototype: achroymicn
uses: to treat syphilis and gonorrhea; some acne cases; broad spectrum and IV route
SE: epigastric discomfort; heartburn; diarrhea; photosensitivity
nrs impl: have PT drink with big glass of water
do not combine with dairy products
Info: Better to take on empty stomach
Do not take tetracycline with anti acid (but can be an hour before or after just not together)
Do no give this drug to 8 y/o causes teeth staining
Macrolides
Prototypes: erythromycin; clarithromycin (biaxen)
uses: mainly used for respiratory tract infections including streptococcal pharyngitis; sinitis; bronchitis and pneumonia. gram positive bacteria
SE: headache; steven-johnson, hepatoxicity, pseudomembranous colitis.
Nrs imp: monitor bowl function; alert the physician at first sign of pseudomembranous colitis
Info: Instruct patient to alert medical staff for rash, fever, blood, pus or mucous present.
Diarrhea needs to be reported ASAP
Tetracycline has a strong affinity for?
calcium
Alteration in intestinal flora may result in?
- superinfection
- diarrhea
- pseudomembranous colitis
True of False: Macrolide is a broad spectrum.
True
Another name for Clarithromycin?
Biaxen
Which drugs can prolong the QT interval?
Emycin and Azithro
Another word for Emycin?
Erythromycin
Erythromycin can prolong the QRS interval? True of False
False, Erythromycin prolongs the QT interval
penicillins
Prototype: amoxicillin (amoxil) 500mg q8h
Uses: Broad spectrum- many gm pos infections
SE: suprainfections; ras; N/V/D; anaphylaxis
Nsg Imps: notify rash; inactivates aminoglycosides
Info: Most common drug allergy
Cephalosporins
prototype drug: 1 gen: cefazolin 2 gen: cefuroxime 3 gen: cefotaxime 4 gen: cefepine
uses: broad spectrum
SE: mild stomach cramps, nausea, vomiting, and diarrhea
Nsg Imps: use lidocaine for IM injections
Info: very similar to penicillin drugs and some PTs allergic to penicillin allergic to cephalosporin
Vancomycin
Prototype: Vancocin
Uses: MRSA and CDIFF
SE: red man syndrome, ototoxic, hypotensions
Ns Imp: if bp or pulse drops notify the physician ASAP; monitor all lab work for an urinary issues; assess skin throughout antibiotic
Info: needs to be administered over an hour, too fast causes red man syndrome
Tetracycline
prototype: achroymicn
uses: to treat syphilis and gonorrhea; some acne cases; broad spectrum and IV route
SE: epigastric discomfort; heartburn; diarrhea; photosensitivity
nrs impl: have PT drink with big glass of water
do not combine with dairy products
Info: Better to take on empty stomach
Do not take tetracycline with anti acid (but can be an hour before or after just not together)
Do no give this drug to 8 y/o causes teeth staining
Macrolides
Prototypes: erythromycin; clarithromycin (biaxen)
uses: mainly used for respiratory tract infections including streptococcal pharyngitis; sinitis; bronchitis and pneumonia. gram positive bacteria
SE: headache; steven-johnson, hepatoxicity, pseudomembranous colitis.
Nrs imp: monitor bowl function; alert the physician at first sign of pseudomembranous colitis
Info: Instruct patient to alert medical staff for rash, fever, blood, pus or mucous present.
Diarrhea needs to be reported ASAP
Side effects of clindamycin?
- Causes the most c.dif of all antibiotics
- rash
What are the 4 big macrocodes “Mycins?”
- Azithromycin (zithromax (take for 3-5 days))
- Clarithomycin (Biaxin)
- Erythromycin (Emycin)
- Dirithromycin (Dynabac)
Clindamycin is used to treat what?
- severe strep infections
- Gangrene (anaerobic)
- MRSA: some resistance
- Useful empirical tx if not sure celluitis is d/t strep or staph
Typical dose of clindamycin?
300mg q6h po or IV
Linezolid (Zyvox) is a new class of drug also known as?
oxazolidinones
Linezolid treats what?
- VRE: Vanco resistant enterococci
- Serious MRSA
Side effects of linezolid?
- neuropathy
- bone marrow suppression
Zyvox is another named for?
Linezolid
Zyvox needs weekly what?
CBC monitoring
clindamycin
prototype: cleocin
uses: anaerobic gm pos/gm neg
Treats: severe strep, gangrene, MRSA
SE: most C. DIFF, rash,, weakness
nrs Imp: asses for infection, obtain specimens for culture and sensitivity prior, monitor bowel elimination
info: administer with full glass of water
Linezolid
Prototype: Zyvox
uses: multidrug resistant to gm positive, used for serious MRSA
SE: neuropathy, bone marrow suppression
NRS Imp: the pt should have a weekly CBC to check for toxicity
Info: should be a last resort; big guns
aminoglycosides
Prototype: gentamycin
uses: serious gram-negative bacillary infections, and infections caused by staphylococci
SE: nephrotoxic, ototoxicity, hypersensitivity
Nrs Imp: give in spate line and time from penicillin
push fluids 2L/day
monitor BUN/CR
Info: blood tests should be done to check for toxicity, commonly found in elderly, perform hearing tests
Sulfas
Prototype: Bactrim
DS at the end means double strength
Uses: Broad spectrum
SE: steven-johnson syndrome (rare), Toxic epidermal necrosis (rare), photosensitivity, hemolytic anemia (rare)
nrs Imp: Push fluids if crystals are found within the urine
Protect the skin from UV light
Check the CBC and assess the skin for changes such as jaundice
Info: Do NOT give to last trimester pregnant, breastfeeding or infants.
Do NOT give to someone who might be on folate deficient
Do NOT give to alcoholic
What is the symptoms of vestibular toxicity (balance center) when on aminoglycosides (gentamycin)?
- 1st symptom is headache, then nausea/dizzy, unsteady on feet.
- Stop drug & contact MD stat for either!
- Educate the pt to tell you if they have these
Aminoglycosides (gentamycin) are used for?
-serious gram negative infections, like pseudomonas.
What route can amino glycosides be used?
Narrow spectrum, IV only. Frequently used in combo w/ other antibiotics
Side effects of amino glycosides?
-irreversible ototoxicity. worse if have renal impairment
What is tinnitus?
Ringing in the ears
What is the symptoms of vestibular toxicity (balance center) when on aminoglycosides (gentamycin)?
- 1st symptom is headache, then nausea/dizzy, unsteady on feet.
- Stop drug & contact MD stat for either!
- Educate the pt to tell you if they have these
What are some side effects of sulfa?
- Stevens-Johnson Syndrome (SJS)
- Toxic Epidermal Necrosis (TEN)
- Photosensitivity “Protect the skin”
- Hemolytic anemia “Check the CBC and look for Jaundice”
- Crystals in urine “Push fluids”
Stevens Johnson Syndrom and Toxic Epidermal Necrosis causes? What is the mortality rate?
- Causes sloughing of skin and mucus membranes.
- Mortality rate 25%
Which drugs contain sulfa?
celebrex, diuretics, thiazides (hctz), sulfonylureas (glipzide, glyburide), silvadene
What must you be careful with sulfa drugs?
don’t give to last trimester pg, breastfeeding, or infants d/t kernicterus (bilirubin deposits in brain) or those who are likely to be folate deficient (megaloblastic anemia)- alcoholic, pg, frail
Nitrofurantoin is used to treat and prevent what?
UTI’s only
What happens to the urine when using nitrofurantoin?
Concentrates in urine and turns urine brown
Your kidney function must be adequate for nitrofurantoin to work. What is the creatinine clearance?
> 40mL/min
Limited use in elderly because of this
What are some side effects of nitrofurantoin?
N/V/D
What must you watch for when taking Flagyl?
- headache
- dry mouth
- fatigue
- metallic, bitter taste
- GI distress
Another name for Flagyl?
Metronidazole
If you take any antibiotics and birth control pills, what happens?
you increase your chance of getting pregnant. Antibiotics decrease the effective of a birth control pill
Clotrimazole (lotrimin) binds with?
the fungal cell membrane altering the permeability of the membrane wall to inhibit its growth
When using lotrimin, watch for what?
N/V/D, adbominal pain, skin irritation, and H/A
What does Lotrimin treat?
use oral, topical, or intravaginal for treatment of candidiasis, tinea pedis, tinea crusis, tinea corporis, tinea versicolor and vulovaginal candidiasis
Antifungals end in what?
-azole
Yeast is an example of ?
fungal
Amphtotericin B is a what drug?
- antifungal drug
- broad spectrum
Tuberculosis is treated with?
Rifampin; always used with another med due to high resistance including MRSA tx
Rifampin makes body fluids what color?
red orange
Hepatotoxicity is ?
toxicity of the liver
-monitor liver function tests and bilirubin levels/jaundice
Nephrotoxicity is?
toxicity of the kidneys
-watch for increased BUN and Creatinine, decreased urine output, protein in urine
What are some TB Medications?
Rifampin, Ethambutol, Pyrazinamide (PZA)
What are some side effects of ethambutol?
SE: optic neuritis-blurred vision, color changes. Assess prior to tx & then monthly
What are some side effects of pyrazinamide?
SE: hepatotoxic- monitor s/s, labs q2wks
Antivirals kill ?
intracellular parasite viruses Anti HSV & HZV (herpes simplex & Zoster virus)
Side effects of Antivirals?
N/V 10%.
Give with food
Metronidazole
Prototype: Flagyl
Uses: against anaerobic bacteria; disrupts DNA and protein synthesis in susceptible organism
SE: headache, dry mouth, fatigue, DI distress
Nrs IMP: administer on an empty stomach, monitor stool samples, monitor I&O
Info: Lab tests may include serum AST, ALT, and LDH tests
Antifungals
Prototype: Butenafine
uses: Topical- cutaneous fungal infections
SE: hypersensitivity to active ingredients
Buring, itching, redness
Nrs Imp: inspect involved areas of skin and mucous membranes before and frequently during administration (if any skin irritation discontinue)
Info: have PT use full course of meds even when feeling better
Ampho B
Prototype: amphotericin
Uses: binds to the fungal cell membrane allowing leakage of cellular contents
SE: hypersensitivity, headache, chest pain, nephrotoxicity, anemia
Nrs Imp: monitor each PT closely after the first dose of chills, fever, headache, and vomiting. Assess the injection site
LAST RESORT
Antivirals: HSV:HZV
prototype: Acyclovir
uses: kill intracellular parasite virus
Dose: 800 mg 5x day for HZV
SE: usually tolerated well, can be safe in pregnancy
NRS Impl: Asses for decrease in lesions
Assess duration of outbreak
If started soon enough within 48 hours of rash can shorten the course
Info: Helps monitor outbreak during childbirth
Neurominidase
Prototype: oseltamivir (Tamiflu)
uses: inhibits neuraminidase , active against influenza A&B
SE: N/V 10%, hypersensitivity, seizures, bronchitis, nausea
Nrs ImP: use correct dosing device measuring oral solution
Treatment should be started within 48 hours of symptoms
