chapter 39, Antibiotics Part 2 Flashcards
Toxicity to the ears, often drug induced and manifesting as varying degrees of hearing loss that is more likely to be permanent.
Ototoxicity
A period of continued bacterial suppression that occurs after brie exposure to certain antibiotic drug classes, especially aminoglycosides and carbapenems
postantibiotic effect
Drug interacting in which the bacterial killing effect of two antibiotics given together is greater than the sum of the individual effects of the same drugs given alone
synergistic effect
Toxicity to the kidneys, often drug induced and manifesting as compromised renal function
Nephrotoxicity
antibacterial drug used to treat infections associated with VRE
Linezolid
An antibiotic drug that is indicated primary for UTIs caused by E. coli, S. aureus, Klebsiella spp, and Enterobacter spp.
Nitrofurantoin (Macrodantin, Furadantin)
what should the nurse warn a patient who is taking nitrofurantoin
That the urine may become dark yellow or brown during therapy.
Patient should report cough, fever, chest pain, difficulty breathing, numbness and tingling of extremities and alopecia.
Fungal infections are evidenced by..
fever
lethargy
perineal itching
anatomically related symptoms
what should the nurse teach a patient who is taking metronidazole
warn the patient that the urine may turn red-brown or a darker color.
caution patient to avoid alcohol and any alcohol containing products such as cough preparations and elixirs due to risk for a disulfiram-like reaction-severe vomiting.
patient should be educated about the purpose of the drug- as either an antibacterial or antifungal.
what should a patient taking linezolid avoid?
tyramine containing foods such as -
red wine
aged cheese
patient teaching for Clindamycin
Topical forms should not be used near the eyes or any abraded areas to avoid irritation. Should it happens accidentally, the eyes should be rinsed immediately with copious amount of cool tap water.
patient should not engage in sexual intercourse for the duration of therapy when vaginal dosage forms are used.
teaching for patient taking Quinolones
Exposure to the sun and tanning beds should be avoided.
Use sunglasses and sunscreen protection.
Report dizziness, restlessness, stomach distress, diarrhea, headache, inflammation of the tendons, confusion and irregular or rapid heartbeat.
drug interactions with oral anticoagulants (warfarin).
What should the nurse teach patients who are taking Aminoglycosides
Purpose and adverse effects; risk for hearing loss,which may occur even after therapy.
forcing fluids up to 3000 mL/day.
Any persistent headache, nausea or vertigo should be reported.
Watching for SxS of superinfection such as;
diarrhea
vaginal discharge
stomatitis
glottitis (black, hair tongue)
loose and foul smelling stools
cough
what assessment should the nurse perform for patients taking vancomycin.
other medications patient is taking.
V/S with close attention to BP during infusion
Bowel patterns because of risk for GI adverse effects.
Urinary patterns due to risk for nephrotoxicity.
baseline hearing status due to risk for ototoxicity.
monitoring trough drug levels.
skin color because of risk for red man syndrome.
fluid and medication interactions.
Assessment for patients taking nitrofurantoin
allergies history of asthma Renal and liver function glucose 6 phosphate dehydrogenase deficiency (increase risk for hemolytic anemia). medication (neurotoxic) skin (color, turgor and intactness) risk for Stevens-Johnson Syndrome. respiratory patterns and breath sounds cough.
Assessment for quinupristin/dalfopristin
V/S
baseline liver and renal function
CBC
GI functioning with focus on bowel patterns, bowel sounds and abdominal pain- because of the potential for antibiotic-associated colitis.
disulfiram like reaction is characterized by..
flushing of the face
tachycardia
palpitations
N/V
What assessments should the nurse perform for patients taking metronidazole
allergies to the drug and other nitroimidazole derivatives.
reviewing C&S report before starting therapy.
neurologic system (dizziness, numbness, tingling)
GI system
GU system
inquire about alcohol intake.
Linezolid assessments
immune status
renal and liver functioning
GI, GU functioning
hematologic functioning
history of infections and response to infection.
presence of jaundice or liver enlargement.
nursing assessments for patients taking quinolones
allergies preexisting CNS conditions (seizure, stroke) bowel activity neuromuscular functioning timing of medication doses-interactions with antacids, iron, multivitamin and zinc (should not be given within 2 hours) blood glucose levels I &O liver and renal functioning.
Assessments that should be performed for patients taking clindamycin
hypersensitivity allergy to aspirin GI patterns presence of abdominal pain WBC, platelet, BUN and creatinine levels
which medications should never be given at the same time with clindamycin
neuromuscular blocking drugs
Aminoglycosides assessments
hypersensitivity preexisting conditions list of all medications baseline hearing test (audiometry vestibular function) renal function studies neuromuscular
A patient receiving vancomycin infusion complains of feeling “Hot” in the face and neck, and itching and those same areas. His face and neck are flushed. What do you suspect is happening?
red man syndrome
the infusion is too rapid
can be alleviated by slowing the rate of infusion to at least 1 hour.
rapid infusion may also cause hypotension.
what is the therapeutic goal when vancomycin levels are monitored?
optimal blood levels are peak level f 18 to 50 mcg/mL.
trough level of 10 to 20 mcg/mL.
because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL.
what happens when the drug levels of vancomycin are too low; less than 5 mcg/mL
the dosage may be subtherapeutic and reduced antibacterial efficacy.
what is the result when the blood levels of vancomycin is too high (over 50 mcg/mL
toxicities results- ototoxicity and nephrotoxicity
An enzyme that renders resistant to all carbapenem antibiotic as well as beta-lactam and monobactams. Produce a very serious resistant to infection.
Klebsiella pneumoniae carbapenemase (KPC)
what is the one of the only drugs available to Tx KPC
colistimethate (Coly-Mycin)
AKA colistin
what are common adverse effects of quinupristin/dalfopristin (synercid)
arthralgias myalgias pain inflammation edma thrombophlebitis
quinupristin/dalfopristin must be infused with
5% dextrose in water only
cannot be mixed with saline or heparin (heparinized flushes)
what teaching about alcohol is important for patients taking metronidazole (Flagyl)
avoid alcohol 24 hours before initiation of therapy and at least 36 hours after the last does.
what is the antibiotic that has excellent oral absorption and allows patients to continue therapy at home for serious infections.
Linezolid
The nurse is reviewing the list of medications for a patient who is been started on linezolid. Which types of medications, if listed would be of most concern?
Selective serotonin reuptake inhibitor antidepressant (SSI)
vasopressive drugs such as dopamine.
what is the most important thing to assess before giving vancomycin?
renal function
what is the best action for the nurse to take when a patient says “I’m hearing old sounds, ringing in my ears during intravenous aminoglycoside therapy.
stop the the infusion immediately and notify the prescriber.
quinolones may have serious interactions with?
oral anticoagulants
when should patients take calcium and magnesium during quinolone therapy
at least 1 hour before or after
The nurse notes that latest trough drug level of a patient who is taking aminoglycoside; tobramycin was 3 mcg/mL. The drug is given daily and the next dose is due in 1 hour. Based on the trough drug level, what is the nurse’s best action?
The does should be held.
notify the prescriber
the normal trough level should be 1 mcg/mL
the patient is at risk for both nephrotoxicity and ototoxicity.
renal function should be checked.
A patient who has been discharged with oral therapy of metronidazole remarks, “I’m so glad to be going home. Our annual office party is tomorrow night, and I’ve been looking forward to it all year along. What is the nurse best response to the patient?
patient must avoid alcohol 24 hours before and 36 after the last dose because of drug interaction.
a patient has been ordered gentamicin (due 0900)and ceftazidme (due 0900 and 2100) intravenously, which antibiotic should the nurse infuse first and why?
the ceftazidime (beta-lactam) should be given first to break down the cell walls to allow the gentamicin (aminoglycoside) to get into the ribosome where they work.
