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NRSG 220 > Chapter 46: Antibiotics > Flashcards

Chapter 46: Antibiotics Flashcards

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1
Q

AMA

A

Substance that kills or inhibits the growth of microorganisms such as bacteria, fungi, or protozoans

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2
Q

Antibiotic Agent

A

Agent kills or inhibits the growth of bacteria

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3
Q

Bacteria are classified as

A
  1. Gram + or Gram -
  2. Shape
  3. O2 ability
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4
Q

Gram + bacteria

A

staphylococcus, streptococcus, enterococcus

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5
Q

Gram (+) bacteria (Some babies eat kangaroo pee)

A

bactericides, escherichia, klebsilla, pseudomonas, salmonella

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6
Q

Aerobic

A

thrive in an oxygen rich environment

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7
Q

anaerobic

A

thrive in a non oxygen rich environment

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8
Q

Abx Classes

A
  1. Penicillins
  2. Cephalosporins
  3. Tetracyclines
  4. Macrolides
  5. Aminoglycosides
  6. Fluroquinolones
  7. Sulfonamides
  8. Miscellaneous abx
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9
Q

Action of Abx drugs

A

affect target organisms structure, metabolism or life cycle

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10
Q

Abx goal

A

To eliminate pathogen

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11
Q

Bactericidal

A

Kill bacteria

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12
Q

Bacteriostatic

A

Slow growth of bacteria

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13
Q

What may abx drugs be used for

A

prophylactic treatment of people with suppressed or compromised immune systems

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14
Q

Abx considerations

A

finish all abx
do not share
keep away from children
decrease in OCP and use back up BC
what foods to take and what to avoid
wear medic-alert bracelets if allergic
skin teeth tendons ears kidneys
assess renal/hepatic function esp in elderly 2.2lb/day
persistant diarrhea in children
take probiotics 1-2x/day to counter antibiotic
monitor for hypersensitivity with first dose
make sure pt knows S&S of allergic rxn
most abx best taken on empty stomach

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15
Q

Penicillins most effective against

A

gram positive bacteria

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16
Q

What allows bacteria to be resistant

A

beta lactamase or penicillinase

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17
Q

Penicillin prototype drug

A

Penicillin G potassium

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18
Q

Penicillin G MOA

A

to kill bacteria by disrupting their cell walls

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19
Q

Penicillin G use

A

Streptococci, pneumococci, staphylococci, gonorrhoea, syphilis

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20
Q

Penicillin G ADEs

A

anaphylaxis
D/N/V
pain at injection site
super infections
drug interactions

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21
Q

Role of nurse in penicillin therapy

A

assess previous reaction to penicillin
avoid cephalosporins if pt has hx of severe penicillin allergy (cross sensitivity) 5-10%
monitor for hyperkalemia and hypernatremia
monitor cardiac status, including ECG changes

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22
Q

Cephalosporins

A

similar in structure and function to penicillin
have beta lacta ring are bactericidal

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23
Q

cephalosporin prototype drug

A

cefazolin

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24
Q

Cephalosporin MOA

A

inhibits cell wall synthesis

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25
Cefazolin uses
gram negative organisms infections of resp, urinary, skin, biliary, bones, joints, genital, septicaemia, endocarditis infections
26
Cefazolin ADEs
hypersensitivity rash itching anaphylaxis D/N/V pain at site drug interactions
27
Role of nurse is cephalosporin therapy
assess for presence or Hx of bleeding disorders (may reduce prothrombin levels) assess renal and hepatic function (esp in elderly) assess persistent diarrhea in children avoid alcohol (can cause disulfiram rxn)
28
Tetracyclines
some of the broadest spectrums of any abx class large number of resistant bacterial strains
29
Tetracyclines drug of choice for
Rocky mt spotted fever PUD chlamydial infections acne
30
Tetracycline prototype drug
tetracycline
31
Tetracycline MOA
inhibit bacterial protein synthesis with bacteriostatic effect
32
Tetracycline Uses
broad spectrum gram + and gram -
33
Tetracycline ADEs
Superinfections N/V/D epigastric burning discolouration of teeth photosensitivity drug interactions
34
Role of the nurse in tetracycline therapy
contraindicated for pt who are pregnant or lactating contraindicated in children less than 8 years of age (permanent teeth mottling) decrease effective of oral contraceptives increase potential for yeast infection while taking OCP and tetracyclines use with caution in pts with impaired kidney or liver function take on empty stomach to increase absorption photosensitivity may result do not take with milk products, iron supplements, laxatives, antacids watch for super infection
35
Macrolides
safe alternatives to penicillin broad spectrum so superinfections may occur
36
Macrolides prototype drug
erythromycin
37
Erythromycin MOA
inhibit protein synthesis by binding to bacterial ribosome
38
Erythromycin Uses
effective against most gram positive and gram negative bacteria
39
Are macrolides bactericidal or bacteriostatic
Bacteriostatic at low doses bactericidal at high doses
40
Erythromycin ADEs
hepatotoxicity N/V abdominal cramping
41
Role of the nurse in macrolide therapy
watch liver with EES erythromycin estolate multiple drug-drug interactions occur with macrolides (CYP) monitor because this exacerbates heart disease cause a metallic taste in mouth
42
Aminoglycosides
Reserved for serious systemic infections caused by aerobic gram negative bacteria more toxic than most abx potential to cause serious ADEs black sheep last names
43
Aminoglycoside prototype
Gentamicin
44
gentamicin MOA
broad spectrum bactericidal (inhibit bacterial protein synthesis)
45
Gentamicin Use
serious urinay, resp, nervous, GI infections
46
Gentamicin ADEs
Ototoxicity (worse w lassie) Nephrotoxicity (worse with Zovirax) neuromuscular blockage
47
Role of the nurse in amino glycoside therapy
hearing loss monitor neuromuscular function impairment increase fluid intake unless contraindicated caution if hypersensitive to sulfites
48
Fluoroquinolone
decreased 90% if taken with multivitamins or minerals such as calcium, magnesium, iron or zinc ions (tetras 50%) NO TEENAGERS OR ATHLETES can cause C diff QT prolongation
49
Fluoroquinolones prototype drug
Ciprofloxacin
50
Ciprofloxacin MOA
inhibits bacterial replication and DNA repair
51
Ciprofloxacin Uses
resp bone joint GI opthlamaic sinitius infections
52
Ciprofloxacin ADEs
GI headache dizziness photosensitivity dysrhythmias liver failure CNS disturbances (1-8%)
53
Role of the nurse in fluoroquinolone therapy
decreased WBC monitor pts with liver and renal dysfunction drug may cause dizziness and lightheadedness may cause photophobia may affect tendons monitor for dysrhytmias crosses into breastmilk
54
Sulfonamides
widespread use has led to increased resistance used in combo to treat UTIs anti-inflammatory properties can help with RA and ulcerative colitis teratogenic do not take while breastfeeding or pregnant caution with 1st dose
55
Sulfonamide prototype drug
Trimethoprim-sulfamethoxazole (tmp/smz)
56
tmp/smz MOA
to kill bacteria by inhibiting bacterial metabolism of folic acid
57
tmp/smz uses
urinary, pneumocystis, pneumonia, shigella, bronchitis
58
tmp/smz ADEs
skin rashes N/V agranulocytosis thrombocytopenia photosensitivity
59
Role of nurse in sulfonamide therapy
assess for anemia or other hematological disorders assessed renal function (can increase risk for crystaluria) ensure back up BC used contraindicated in pts w Hx of SJS how to decrease effects of photosensitivity
60
Carbapenems
antibiotics used for the treatment of infections known or suspected to be caused by MDR bacteria used in hospitalized ppl low incidence of ADEs
61
Glycopeptides
vancomycin breaks down amino acid wall used to treat C diff
62
Glycosamides
clindamycin (IV only) can cause C diff
63
Miscellaneous Prototype
vancomycin
64
vancomycin MOA
bactericidal, inhibits cell wall synthesis
65
vancomycin Uses
reserved for severe or resistant gram positive infection, effective for MRSA and C diff
66
Vancomycin ADEs
ototoxicity, nephrotoxicity, red man syndrome, confusion/hallucinations, anaphylaxis
67
Nitroimidazoles
flagyl treats anaerobic bacterial infections and protozoal infections inhibits DNA synthesis watch liver
68
Nitroimidazoles ADEs
dark red/brown urine metallic taste in mouth seizures N/V/D SJS
69
Daptomycin
A lipopeptide antibiotic used in tat of systemic and life threatening infections caused by gram positive organisms useful in treating MDR infections
70
Acquired resistance
as abx are used, they destroy sensitive bacteria
71
ARO's
CBO ESBL MRSA VRE VRSA
72
Multidrug resistant
when an organism is resistant to more than one drug
73
What to teach patients about acquired resistance
teach pts to take full course do not save abx or share with others abx do not treat viral infections over prescribing has a lead to ARO C&S prior to treatment id preferable
74
Culture and sensitivity testing
ideally lab test are conducted prior to anti-infective therapy organisms are grown in the laboratory several abx are tested for effectiveness may take days or weeks for results using a specific abx may decrease antagonism and resistance
75
superinfections
secondary infections that occur when too many host flora are killed by abx
76
Host flora
Stop growth of pathogenic organisms by - making antibacterial substances - competing for space and nutrients
77
Signs and symptoms of superinfections
diarrhea (C diff) bladder pain and painful urination (e coli) abnormal vaginal discharge (yeast candida) red rash with satellite lesions (yeast candida)
78
When should you suspect C difficile
1. 3 or more episodes of unformed stool in 24 hours and elevated WBC 2. Diarrhea during or up to 6 weeks after antibiotic therapy 3. Diarrhea following hospital discharge or 72 hours after admission
79
why should all antidiarrheals, antibiotics and proton pump inhibitors be stopped?
Antidiarrheal may mask tat failure or worsening diarrhea overuse of antibiotic therapy for co existing conditions may lead to C diff proton pump inhibitors may increase risk for C diff
80
If antibiotic overuse can lead to C difficile, then why is it ordered for treatment
for mild to moderate C diff, PO/NG routes mean it will stay longer in the gut thus provide the best treatment - IV routes are not as effective once it become severe, oral or rectal vancomycin is the best treatment

NRSG 220 (8 decks)

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