Class 12: Antibiotic therapy & pharmacology + anti-inflammatory medication Flashcards
(186 cards)
1
Q
If cultures are not taken before administering antibiotics..
A
They can mislead the results of cultured specimens and prolong therapy
2
Q
Gram-negative infections are…
A
Generally harder to treat because of the more complex cell walls
3
Q
Gram-stain classification
A
-Purple stains= gram-positive and red stains are gram-negative
-Helps practioners determine the most suitable antibiotics
4
Q
Superinfections
A
-A complex infection that can occur during or after antimicrobial treatment for another infection
-Can occur when antibiotic therapy is sub-therapeutic
-In antibiotic therapy, healthy gut flora can be killed allowing other types of bacteria to take over
5
Q
Examples of superinfections
A
MRSA, VRE and C. Diff.
6
Q
Sub-therapeutic therapy occurs when…
A
S&S do not seem to be improving
7
Q
Sub-therapeutic therapy can be d/t
A
Incorrect route, inadequate drainage of an abscess, poor drug penetration, insufficient drug levels or bacterial resistance
8
Q
Types of antibiotics
A
Sulfonamides, macrolides, B-lactam antibiotics, ahminoglycosides, tetracyclines, fluoroquinolones and miscellaneous antibiotics
9
Q
B-lactam antibiotics
A
-PMCC
-Penicillins, monobactams, cephalosporins and carbapenems
10
Q
Miscellaneous antibiotics
A
Vancomycin, clindamycin and metronidazole
11
Q
4 main sites of action for antibiotic therapy
A
-Interfere with cell wall or protein synthesis
-Interfere with DNA replication & RNA synthesis
-Interfere with bacteria cell metabolism
12
Q
Bactericidal antibiotics does what and includes which antibiotics?
A
-Kills bacteria
-AdoubleCtripleM,PFV
-Aminoglycosides, cephalosporins, carbapenems, macrolides, monobactams, metronidazole, penicillins, fluoroquinolones and vancomycin
13
Q
Bacteriostatic antibiotics
A
-Do not kill, only inhibits growth
-MCATS
-Macrolides, clindamyscin, aminoglycosides, tetracyclines and sulfanomides
14
Q
[ ] means
A
Concentration
15
Q
Sulfonamide general information
A
-First drugs ever used as antibiotics.
-Combined with trimethoprim for synergistic effects
16
Q
Sulfonamide indications
A
-Broad spectrum antibacterial activity against gram-positive & gram-negative bacteria
-Commonly used for UTIs, respiratory tract infections and general prophylaxis
17
Q
Sulfonamide MOA
A
-Bacteriostatic antibiotics
-Inhibit bacteria growth rather than destroy it by affecting its metabolism (folic acid)
18
Q
Sulfonamide adverse effects
A
-“Sulfa allergy”, starts with a fever then can proceed to a rash
-Photosensitivity; exposure to sunlight causes a rash
-Anemias, skin reactions, Stevens-Johnson syndrome, pancreatitis, convulsions, headaches, crystalluria and toxic nephrosis
19
Q
Sulfonamide contraindications/drug interactions
A
-Sulfonylureas for DM
-Cyclosporin inhibits immunosupressant effects
-Phenytoin can increase the risk for toxicity
-Warfarin increases the anticoagulant effects
-Pregnant woman, geriatrics and children under 2
20
Q
Sulfonamide nursing implications
A
-Severe allergies? Hx of renal disease? Therapeutic response?
-Monitor skin & bowel function
-Re-evaluate lab work
21
Q
Macrolide general information
A
-Became popular in the 1950’s with the introduction of erythromycin
-Longer duration resulting in fewer required doses
-Use if pt is allergic to a B-lactam
22
Q
Macrolide indications
A
-Respiratory tract infections
-Skin and soft tissue infections
-STIs
23
Q
Macrolide MOA
A
-Bacteriostatic antibiotic but in high enough [ ]’s it can be considered bactericidal in nature
-Inhibits bacterial protein synthesis (binds to the ribosomes 50S subunit inside of the bacteria cell causing them to eventually die)
24
Q
Macrolide adverse effects
A
GI upset is the most common
25
Macrolide contraindications
Decrease the efficacy of oral contraceptives, pregnanct women & in geriatric patients
26
Macrolide drug interactions
-Competes for liver metabolism with many different drugs because it is highly protein bound
-Ex) carbamazepine, cyclosporine, digoxin, theophylline and warfarin
27
Macrolide nursing implications
-Severe allergies? Therapeutic response?
-Monitor skin & bowel function
-Re-evaluate lab work- May see elevated liver enzymes
28
B-lactam antibiotics are characterized by the..
Chemical structure that involves a β-lactam ring
29
B-lactam has a ...
Time dependant killing action and relies on time vs. a specific [ ] of antibiotic
30
Types of B-lactam antibiotics
Cephalosporins, carbapenems, monobactams and penicillins
31
Penicillin general information
-Derived from mould fungus and is often found on bread or fruit
-The broad-spectrum penicillins (amoxicillin, ampicillin) were introduced in WWII and have remained well-trusted antibiotics to date
32
Penicillin is a...
Broad spectrum antibacterial activity against gram-positive and limited activity with gram-negative bacteria
33
Penicillin has a..
Narrow spectrum
34
Penicillin indications
-Streptococcus, enterococcus and staphylococcus
-Ear infections, pneumonia, UTIs, STIs and prophylaxis prior to surgery
35
Penicillin MOA
-Bactericidal
-Inhibit bacteria cell wall synthesis by infiltrating the cell which makes it unstable and breaks it down
36
Penicillin adverse effects
-GI upset is most common
-Allergic reactions include urticaria, pruritus and angioedema
-Unpredictable drug reactions include maculopapular eruptions, eosinophilia, Stevens-Johnson syndrome and exfoliative dermatitis
37
Penicillin drug interactions
-Additional antibiotics have additive/inhibitory effects
-NSAIDS compete for protein binding which could result in more active & free penicillin
-Oral contraceptives decrease its effectiveness
-Potassium supplements may increase effects of hyperkalemia
-Warfarin
38
Penicillin nursing implications
-Monitor skin & bowel function
-Re-evaluate lab work
-Evaluate therapeutic response
39
Cephalosporin general information
-Derived from a fungus but is synthetically altered to produce an antibiotic that is very similar to penicillins
-4-5 different generations
40
Cephalosporins have a...
Broad spectrum antibacterial activity against gram-positive and limited activity with gram-negative bacteria
41
Each new generation of cephalosporin can...
Focus on different bacterial strains
42
Cephalosporin indications
UTIs & respiratory infections
43
Cephalosporin MOA
-Bactericidal action
-Inhibits bacteria cell wall synthesis by infiltrating the cell and binding to proteins making it unstable and breaking it down
44
Cephalosporin adverse effects, contraindications/drug interactions and nursing implications are
Similar to penicillin antibiotics (go back)
45
Monobactam general information
Not marketed in Canada
46
Monobactam is...
Primarily active against gram-negative bacteria
47
Monobactam indications
Used for moderately severe systemic infections and UTI’s
48
Monobactam MOA
-Bactericidal action
-Inhibits bacteria cell wall synthesis by infiltrating the cell and binding to proteins making it unstable and breaking it down
49
Carbapenem general information
-Broadest antibacterial action of any antibiotics
-Potent & heavy hitting antibiotics
-Immune to the effects of B-lactamase
50
Carbapenem is often...
Reserved for complicated body cavity and connective tissue infections in acutely ill hospitalized patients
51
Carbapenam is a...
Broad spectrum antibacterial activity against gram-positive & gram-negative bacteria
52
Carbapenem indications
-Bone, joint, skin, and soft tissue infections; bacterial endocarditis, intra-abdominal infections, pneumonias, UTI’s, pelvic infections and bacterial septicemia
53
Meropenem is the...
Only drug effective for bacterial meningitis
54
Carbapenem MOA
-Bactericidal action
-Inhibits bacteria cell wall synthesis by infiltrating the cell and binding to proteins making it unstable and breaking it down
55
Carbapenem adverse effects
-Seizures and confusion**
-GI upset & rash
56
Carbapenem drug interactions
Cyclosporin, ganciclovir & probenecid may cause CNS adverse effects (seizures/confusion)
57
Carbapenem contraindications
Pregnancy, hx of renal disease, geriatrics and seizures disorders
58
Carbapenem nursing implications
Monitor skin, bowel, therapeutic response and CNS function
-Re-evaluate lab work
59
Tetracycline general information
Most commonly given PO in a tab/cap
60
Tetracycline indications
-Wide range antibiotic (Both Gram +/-)
-Acne, chlamydia, pneumonia’s, UTI’s and skin infections
61
Tetracycline MOA
-Bacteriostatic
-Protein synthesis inhibitor
62
Tetracycline adverse effects
-Discolouration of teeth in fetuses and children and disrupted fetal skeletal development if taken during pregnancy
-Photosensitivity (sunburn), diarrhea, yeast Infection and aUrine colour
63
Tetracycline contraindications
-Pregnancy/breastfeeding
-Children under 8 years old
-When taken with calcium & iron
64
Tetracycline drug interactions
Anticoagulants, bactericidal antibiotics & oral contraceptives
65
Tetracycline nursing implications
-Take 1 hour before or 2 hours after meals/snack
-Take at least 4 hours after antacid
-Do not take with food especially dairy products
-Administer around the clock
66
Aminoglycoside general information
-Very Potent
-Not given orally d/t poor absorption
-Usually given with Beta-Lactams/ Vancomycin to provide a synergistic effect
67
Aminoglycoside fights...
Mostly gram negative & some gram positive
68
Aminoglycoside indications
Serious infections, GI/GU infections, endocarditis and respiratory tract infections
69
Aminoglycoside MOA
Bactericidal, protein synthesis inhibitor and disrupts the cell membrane
70
Aminoglycoside adverse effects
Ototoxicity, nephrotoxicity and drug toxicity
71
Aminoglycoside contraindications
Renal impairment and pregant or breastfeeding women
72
Aminoglycoside drug interactions
Loop diuretics and oral anticoagulants
73
Aminoglycoside implications
-Renal Assessment
-Neurological assessment; dizziness, vertigo, tinnitus, roaring in ears and hearing loss
-Therapeutic drug monitoring
74
Fluoroquinolones general information
Very potent
75
Fluoroquinolones are for...
Mostly gram negative and some gram positive
76
Fluoroquinolone indications
Complicated UTI’s and respiratory tract infections
-Skin, GI, bone, and joint infections
77
Fluoroquinolone MOA
-Bactericidal
-Alter DNA of bacteria
78
Fluoroquinolone adverse effects
Central nervous, skin, GI, elevated ALT/AST, and prolonged QT interval
79
Fluoroquinolone contraindications
Cardiac dysrhythmias
80
Fluoroquinolone drug interactions
Antacids, anticoagulants, calcium/magnesium, bronchodilators and iron/zinc preparations
81
Fluoroquinolone nursing implications
-May be taken with meals (except dairy alone)
-Reduce caffeine if excessive cardiac or CNS stimulation occurs
-Maintain hydration/urine output
82
Clindamycin general information
Derived from old antibiotic lincomycin
83
Clindamycin is for...
Both gram + & -
84
Clindamycin indications
Chronic bone infections, UTI’s, intra-abdominal infections, anthrax, endocaditis and malaria
85
Clindamycin MOA
-Can be both bactericidal/static based on the dose
-Protein synthesis inhibitor
86
Clindamycin adverse effects
GI upset, joint pain, thrush and yeast infection
87
Clindamycin contraindications/drug interactions
-Ulcerative colitis
-Neuromuscular drugs
88
Clindamycin nursing implication
-May be taken with food
-Bowel assessment
89
Metronidazole general information
-Flagyl
-Class: Nitroimidazole
90
Metronidazole indications
Intra-abdominal and gynaecological infections
91
Metronidazole MOA
-Bactericidal
-Alter DNA of bacteria
92
Metronidazole adverse effects
GI, nasal congestion, neutropenia and thrombocytopenia
93
Metronidazole contraindications
Breastfeeding mother
94
Metronidazole drug interactions
Antidepressants, ETOH, Li+, benzodiazepine, cyclosporin and CCBs
95
Metronidazole nursing implications
-Keep hydrated
-Take on full stomach to avoid digestive upset
96
Vancomycin general information
Treatment of choice for MRSA
97
Vancomycin indications
MRSA, C. diff, bone and bloodstream infections
98
Vancomycin MOA
-Bactericidal
-Destroys bacteria cell wall causing cell death
99
Vancomycin adverse effects
Ototoxicity, nephrotoxicity, 'Red Man Syndrome’ and neutropenia
100
Vancomycin contraindications
-Hearing condition and kidney dysfunction
-Take caution with neonates/older adults
101
Vancomycin drug interactions
Neuromuscular blockers
102
Vancomycin nursing implications
Therapeutic drug dose, stay hydrated & monitor U/O
103
Definition of inflammation
A localized protective response stimulated by injury to tissues, which serves to destroy, dilute, or wall off both the injurious agent and the injured tissue
104
Anti-inflammatory medication MOA
Blocks the arachidonic acid (repair®row) pathway
105
Anti-inflammatory medications
Nonsteroidal & corticosteroids
106
Salicylates
Aspirin & diflunisal
107
Acetic acid derivatives
-Diclofenac Na+, indomethacin suindac, etodolac, ketorolac and mefenamic acid
-Things that end in "ic" OR "ac" (puts the "ace" in acetic acid)
108
COX-2 Inhibitors
Celecoxib
109
Enolic acid derivatives
Nabumentone, meloxicam and piroxicam
110
Propionic acid derivatives
-Flurbiprofen, ibuprofen, ketoprofen, naproxen and oxaprozin tioprofenic
-Things that have "pro" in them
111
NSAID
Large group of medications accounting for over 4% of all prescriptions in Canada
112
4 primary properties
Analgesics, anti-inflammatory, anti-arthritic and antipyretic activities
113
NSAIDS are used for...
Mild-moderate headaches, myalgia, neuralgia and arthraigia, alleviation of post operative pain and inhibition of platelet aggregation
114
Arthritic disorders such as
Ankylosing spondylitis, and tx of gout & hyperuricemia
115
Recommended NSAID for ankylosing spondylitis
Indomethacin, naproxen and flurbiprofen
116
Recomended NSAID diabetic neuropathy
Sulindac
117
Recommended NSAID for dysmenorrhea
Fenamates, naproxen and ibuprofen
118
Recommended NSAID for gout
Indomethacin, naproxen and sulindac
119
Recommended NSAID for headaches
Aspirin, ibuprofen and naproxen
120
Recommended NSAID for hepatotoxicity
Naproxen, ibuprofen, piroxicam and fenamates
121
Recommended NSAID for a hx of aspirin or NSAID allergy
Avoid NSAIDs if possible; if deemed necessary, consider a nonacetylated salicylate
122
Recommended NSAID for HTN
Sulindac, nonacetylated salicylate, ibuprofen and etodolac
123
Recommended NSAID for OA
Diclofenac, oxaprozin and indomethacin
124
Recommended NSAID for pt at risk for GI toxicity
All COX-2 inhibitors
125
Recommended NSAID for pt at risk for nephrotoxicity
Sulindac, nonacetylated salicylate, nabumetone, etodolac, diclofenac and oxaprozin
126
Recommended NSAID for warfarin therapy
Sulindac, naproxen, ibuprofen and oxaprozin
127
Contraindications of NSAID use
-Conditions that place the pt at risk for bleeding; epistaxis, vitamin K deficiency and PUD
-Not recommended for breastfeeding mothers and take caution in pregnant women
128
Anti-inlammatory adverse effects on CV
Moderate to severe noncardiogenic pulmonary edema
129
Anti-inflammatory adverse effects on GI
Dyspepsia, heartburn, epigastric distress, N/V, anorexia, abd pain, GIB, mucosal lesions
130
Anti-inflammatory hematological adverse effects
aHemostasis through effects on platelet function
131
Anti-inflammatory hepatic adverse effects
Acute reversible hepatotoxicity
132
Anti-inflammatory adverse effects on the renal system
Reduction in CrCl and tubular necrosis w kidney failure
133
Other anti-inflammatory adverse effects
Skin eruption, sensitivity reactions, tinnitus and hearing loss
134
Anti-inflammatory interaction with ETOH
Additive effect that may cause a GIB
135
Anti-inflammatory interaction with anticoagulants
Platelet inhibition and hypoprothrombinemia which increases bleeding tendencies
136
Anti-inflammatory interaction with antihyperglycemic drugs
Increased antihyperglycemic response to sulfoneureas which reduces BG
137
Antiinflammatory interaction with SA and other salicylates with NSAIDs
Reduces NSAID absorption and has additive GI toxicities which increase GI toxicity with therapeutic advantage
138
Anti-inflammatory interaction with corticosteroids and other ulcerogenic drugs
Additive toxicities and increased ulcerogenic effect
139
Anti-inflammatory interaction with cyclosporines
Inhibits kidney prostaglandin synthesis and increases the nephrotoxic effects of cyclosporine
140
Anti-inflammatory interactions with hypotensive drugs & diuretics
Inhibits prostaglandin synthesis and reduces hypotensive/diuretic effects
141
Anti-inflammatory interaction with phenytoin
Inhibit phenytoin metabolism and increases its serum levels
142
Anti-inflammatory interactions with protein-bound drugs
Compete for binding and more pronounced drug actions
143
Anti-inflammatory interactions with uricosurics
Antagonistic effect that reduces uric acid secretion
144
NSAID overdose S&S
Lethargy, drowsiness, confusion, disorientation, paraesthesia, numbness, aggression & seizures
145
GI toxicities + anti-inflammatories
N/V & GIB
146
Adverse effects of anti-inflammatories
GI toxicity, headache, dizziness, cerebral edema, cardiac arrest & death
147
CVD risk + NSAIDs
-May increase the risk of thrombosis
-NSAIDs are contraindicated in the perioerative CABG setting
148
GI risk + NSAIDs
Elderly pt are at greater risk
149
Anti-inflammatory meds + lab values to monitor
-Hemoglobin, hematocrit, hyperkalemia, hyponatremia, AST & ALT (hepatotoxicity is rare)
150
Specific conditions r/t NSAIDs
Gout & Reye's syndrome
151
Gout
-Elevated uric acid crystals in tissues/joints
152
Allopurinol + gout
Prevents uric acid production
153
Colchicine + gout
Reduces the inflammatory response to deposits of uric crystals; used in acute tx
154
Reye's syndrome
Aspirin is contraindicated in children with viral illnesses and may result in encephalopathy or liver damage
155
S&S of Reye's syndrome
aLOC, coma, flaccid paralysis, loss of deep tendon reflexes, seizures & vomiting
156
Corticosteroids
Mineralocorticoids & glucocorticoids
157
Mineralocorticoids
Aldosterone; regulates Na+, influences K+ & causes metabolic alkalosis
158
Glucocorticoids
-Also have anti-inflammatory properties
-Systemic or topical glucocorticoids are available in short, intermediate and long acting forms
159
All naturally occuring corticosteroids in the body are...
Available in exogenous form
160
Systemic glucocorticoids
-Prednisone; oral and intermediate acting
-Solu-cortef: Hydrocortison Na+, IV form
161
Corticosteroids MOA
r/t the synthesis of specific proteins & indirectly modify enzyme activity
162
Mineralocorticoid aldosterone
Effect fluid & electrolyte balance on the distal kidney tubule
163
Glucocorticoid hydrocortisone
Inhibits inflammatory & immune response
164
Corticosteroids control the...
Inflammatory response by stabilizing cell membranes
165
Corticosteroid indications (1)
Allergies, bacterial meningitis, cancers, cerebral edema, chronic respiratory illness, skin disease and endocrine disorders
166
Corticosteroid indications (2)
-GI, rheumatic & hematological disorders
-Nonrheumatic inflammation, nephrotic syndrome, organ transplant, leukemias and lymphomas
167
Corticosteroid contraindications
Cataracts, glaucoma, PUD, mental health concerns and DM
168
Corticosteroid CV adverse effects
-HF, cardiac edema and HTN—all caused by electrolyte imbalances (hyperkalemia, hyponatremia)
-Impaired glucose tolerance, dysrhythmias, bradycardia, pulmonary edema, syncope and vasculitis
169
Corticosteroid CNS adverse effects
Convulsions, vertigo, mood swings, nervousness, aggressive behaviours, psychotic symptoms, neuritis, peripheral neuropathy, paresthesia, arachnoiditis, meningitis and insomnia
170
Corticosteroid endocrine system adverse effects
Growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, hypothalamic–pituitary–adrenal axis suppression, hirsutism, hypertrichosis and glycosuria
171
Corticosteroid GI adverse effects
Peptic ulcers, pancreatitis, ulcerative esophagitis and abdominal distension
172
Corticosteroid skin adverse effects
Fragile, dry, hyperpigmented, petechiae, ecchymosis, facial erythema, poor wound healing, urticaria, acne and stria
173
Corticosteroid MSK adverse effects
Myopathy, atrophy, osteoporosis, osteonecrosis of femoral & humeral heads, pathological fracture and malaise
174
Corticosteroid ocular adverse effects
IIOP, glaucoma & cataracts
175
Corticosteroid "other" adverse effects
Weight gain, leukocytosis, opportunistic infections, hypokalemia and alkalosis
176
Systemic corticosteroid interactions with non-potassium sparing diuretics
Hypocalcemia & hypokalemia
177
Systemic corticosteroid interactions with aspirin & other NSAIDS
GI effects and gastric ulcer development
178
Systemic corticosteroid interactions with cholinesterase drugs
Weakness with myasthenia gravis
179
Systemic corticosteroid interactions with immunizing biologics
Inhibit immune response
180
Systemic corticosteroid interactions with antidiabetic drugs
Elevated blood glucose
181
Glucocorticoid pt teachings
-Adrenal crisis may occur if glucocorticoid is abruptly stopped
-Glucocorticoid inhalers require mouth rinse to prevent fungal infections
-Surgeon must be aware of pt taking glucocorticoid. Pt may be switched to rapid acting medication. Dose may need to be increased in the immediate post-op period
182
Routes of corticosteroids
PO, IM, IV, intranassally & inhaled
183
Corticosteroids cause...
Endogenous glucocorticoid levels to decrease. For levels to resume, exogenous levels must be decreased gradually so that hormone output responds to the negative feedback system. Abrupt withdrawal may lead to Addison’s disease
184
Do not give corticosteroids with...
Aspirin or other NSAIDS to minimize the risk of gastric irritation and possible gastric bleeding from compounding ulcerogenic effects
185
Oral corticosteroids should be...
Given with milk or food to help minimize GI upset
186
Monitor blank with corticosteroids
Therapeutic response and adverse effects including Cushing’s syndrome
