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NRSG 220 > Chapter 46: Antibiotics > Flashcards

Chapter 46: Antibiotics Flashcards

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
Q

Cefazolin uses

A

gram negative organisms
infections of resp, urinary, skin, biliary, bones, joints, genital, septicaemia, endocarditis infections

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26
Q

Cefazolin ADEs

A

hypersensitivity
rash
itching
anaphylaxis
D/N/V
pain at site
drug interactions

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27
Q

Role of nurse is cephalosporin therapy

A

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)

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28
Q

Tetracyclines

A

some of the broadest spectrums of any abx class
large number of resistant bacterial strains

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29
Q

Tetracyclines drug of choice for

A

Rocky mt spotted fever
PUD
chlamydial infections
acne

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30
Q

Tetracycline prototype drug

A

tetracycline

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31
Q

Tetracycline MOA

A

inhibit bacterial protein synthesis with bacteriostatic effect

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32
Q

Tetracycline Uses

A

broad spectrum gram + and gram -

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33
Q

Tetracycline ADEs

A

Superinfections
N/V/D
epigastric burning
discolouration of teeth
photosensitivity
drug interactions

34
Q

Role of the nurse in tetracycline therapy

A

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
Q

Macrolides

A

safe alternatives to penicillin
broad spectrum so superinfections may occur

36
Q

Macrolides prototype drug

A

erythromycin

37
Q

Erythromycin MOA

A

inhibit protein synthesis by binding to bacterial ribosome

38
Q

Erythromycin Uses

A

effective against most gram positive and gram negative bacteria

39
Q

Are macrolides bactericidal or bacteriostatic

A

Bacteriostatic at low doses
bactericidal at high doses

40
Q

Erythromycin ADEs

A

hepatotoxicity
N/V
abdominal cramping

41
Q

Role of the nurse in macrolide therapy

A

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
Q

Aminoglycosides

A

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
Q

Aminoglycoside prototype

A

Gentamicin

44
Q

gentamicin MOA

A

broad spectrum bactericidal (inhibit bacterial protein synthesis)

45
Q

Gentamicin Use

A

serious urinay, resp, nervous, GI infections

46
Q

Gentamicin ADEs

A

Ototoxicity (worse w lassie)
Nephrotoxicity (worse with Zovirax)
neuromuscular blockage

47
Q

Role of the nurse in amino glycoside therapy

A

hearing loss monitor
neuromuscular function impairment
increase fluid intake unless contraindicated
caution if hypersensitive to sulfites

48
Q

Fluoroquinolone

A

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
Q

Fluoroquinolones prototype drug

A

Ciprofloxacin

50
Q

Ciprofloxacin MOA

A

inhibits bacterial replication and DNA repair

51
Q

Ciprofloxacin Uses

A

resp bone joint GI opthlamaic sinitius infections

52
Q

Ciprofloxacin ADEs

A

GI
headache
dizziness
photosensitivity
dysrhythmias
liver failure
CNS disturbances (1-8%)

53
Q

Role of the nurse in fluoroquinolone therapy

A

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
Q

Sulfonamides

A

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
Q

Sulfonamide prototype drug

A

Trimethoprim-sulfamethoxazole (tmp/smz)

56
Q

tmp/smz MOA

A

to kill bacteria by inhibiting bacterial metabolism of folic acid

57
Q

tmp/smz uses

A

urinary, pneumocystis, pneumonia, shigella, bronchitis

58
Q

tmp/smz ADEs

A

skin rashes
N/V
agranulocytosis
thrombocytopenia
photosensitivity

59
Q

Role of nurse in sulfonamide therapy

A

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
Q

Carbapenems

A

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
Q

Glycopeptides

A

vancomycin
breaks down amino acid wall
used to treat C diff

62
Q

Glycosamides

A

clindamycin (IV only)
can cause C diff

63
Q

Miscellaneous Prototype

A

vancomycin

64
Q

vancomycin MOA

A

bactericidal, inhibits cell wall synthesis

65
Q

vancomycin Uses

A

reserved for severe or resistant gram positive infection, effective for MRSA and C diff

66
Q

Vancomycin ADEs

A

ototoxicity, nephrotoxicity, red man syndrome, confusion/hallucinations, anaphylaxis

67
Q

Nitroimidazoles

A

flagyl
treats anaerobic bacterial infections and protozoal infections
inhibits DNA synthesis
watch liver

68
Q

Nitroimidazoles ADEs

A

dark red/brown urine
metallic taste in mouth
seizures
N/V/D
SJS

69
Q

Daptomycin

A

A lipopeptide antibiotic used in tat of systemic and life threatening infections caused by gram positive organisms
useful in treating MDR infections

70
Q

Acquired resistance

A

as abx are used, they destroy sensitive bacteria

71
Q

ARO’s

A

CBO
ESBL
MRSA
VRE
VRSA

72
Q

Multidrug resistant

A

when an organism is resistant to more than one drug

73
Q

What to teach patients about acquired resistance

A

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
Q

Culture and sensitivity testing

A

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
Q

superinfections

A

secondary infections that occur when too many host flora are killed by abx

76
Q

Host flora

A

Stop growth of pathogenic organisms by
- making antibacterial substances
- competing for space and nutrients

77
Q

Signs and symptoms of superinfections

A

diarrhea (C diff)
bladder pain and painful urination (e coli)
abnormal vaginal discharge (yeast candida)
red rash with satellite lesions (yeast candida)

78
Q

When should you suspect C difficile

A
  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
Q

why should all antidiarrheals, antibiotics and proton pump inhibitors be stopped?

A

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
Q

If antibiotic overuse can lead to C difficile, then why is it ordered for treatment

A

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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