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488 > Class 12: Antibiotic therapy & pharmacology + anti-inflammatory medication > Flashcards

Class 12: Antibiotic therapy & pharmacology + anti-inflammatory medication Flashcards

1
Q

If cultures are not taken before administering antibiotics..

A

They can mislead the results of cultured specimens and prolong therapy

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2
Q

Gram-negative infections are…

A

Generally harder to treat because of the more complex cell walls

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3
Q

Gram-stain classification

A

-Purple stains= gram-positive and red stains are gram-negative
-Helps practioners determine the most suitable antibiotics

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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

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5
Q

Examples of superinfections

A

MRSA, VRE and C. Diff.

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6
Q

Sub-therapeutic therapy occurs when…

A

S&S do not seem to be improving

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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

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8
Q

Types of antibiotics

A

Sulfonamides, macrolides, B-lactam antibiotics, ahminoglycosides, tetracyclines, fluoroquinolones and miscellaneous antibiotics

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9
Q

B-lactam antibiotics

A

-PMCC
-Penicillins, monobactams, cephalosporins and carbapenems

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10
Q

Miscellaneous antibiotics

A

Vancomycin, clindamycin and metronidazole

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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

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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

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13
Q

Bacteriostatic antibiotics

A

-Do not kill, only inhibits growth
-MCATS
-Macrolides, clindamyscin, aminoglycosides, tetracyclines and sulfanomides

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14
Q

[ ] means

A

Concentration

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15
Q

Sulfonamide general information

A

-First drugs ever used as antibiotics.
-Combined with trimethoprim for synergistic effects

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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

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17
Q

Sulfonamide MOA

A

-Bacteriostatic antibiotics
-Inhibit bacteria growth rather than destroy it by affecting its metabolism (folic acid)

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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

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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

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20
Q

Sulfonamide nursing implications

A

-Severe allergies? Hx of renal disease? Therapeutic response?
-Monitor skin & bowel function
-Re-evaluate lab work

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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

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22
Q

Macrolide indications

A

-Respiratory tract infections
-Skin and soft tissue infections
-STIs

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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)

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24
Q

Macrolide adverse effects

A

GI upset is the most common

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25
Q

Macrolide contraindications

A

Decrease the efficacy of oral contraceptives, pregnanct women & in geriatric patients

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26
Q

Macrolide drug interactions

A

-Competes for liver metabolism with many different drugs because it is highly protein bound
-Ex) carbamazepine, cyclosporine, digoxin, theophylline and warfarin

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27
Q

Macrolide nursing implications

A

-Severe allergies? Therapeutic response?
-Monitor skin & bowel function
-Re-evaluate lab work- May see elevated liver enzymes

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28
Q

B-lactam antibiotics are characterized by the..

A

Chemical structure that involves a β-lactam ring

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29
Q

B-lactam has a …

A

Time dependant killing action and relies on time vs. a specific [ ] of antibiotic

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30
Q

Types of B-lactam antibiotics

A

Cephalosporins, carbapenems, monobactams and penicillins

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31
Q

Penicillin general information

A

-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

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32
Q

Penicillin is a…

A

Broad spectrum antibacterial activity against gram-positive and limited activity with gram-negative bacteria

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33
Q

Penicillin has a..

A

Narrow spectrum

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34
Q

Penicillin indications

A

-Streptococcus, enterococcus and staphylococcus
-Ear infections, pneumonia, UTIs, STIs and prophylaxis prior to surgery

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35
Q

Penicillin MOA

A

-Bactericidal
-Inhibit bacteria cell wall synthesis by infiltrating the cell which makes it unstable and breaks it down

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36
Q

Penicillin adverse effects

A

-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

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37
Q

Penicillin drug interactions

A

-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

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38
Q

Penicillin nursing implications

A

-Monitor skin & bowel function
-Re-evaluate lab work
-Evaluate therapeutic response

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39
Q

Cephalosporin general information

A

-Derived from a fungus but is synthetically altered to produce an antibiotic that is very similar to penicillins
-4-5 different generations

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40
Q

Cephalosporins have a…

A

Broad spectrum antibacterial activity against gram-positive and limited activity with gram-negative bacteria

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41
Q

Each new generation of cephalosporin can…

A

Focus on different bacterial strains

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42
Q

Cephalosporin indications

A

UTIs & respiratory infections

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43
Q

Cephalosporin MOA

A

-Bactericidal action
-Inhibits bacteria cell wall synthesis by infiltrating the cell and binding to proteins making it unstable and breaking it down

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44
Q

Cephalosporin adverse effects, contraindications/drug interactions and nursing implications are

A

Similar to penicillin antibiotics (go back)

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45
Q

Monobactam general information

A

Not marketed in Canada

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46
Q

Monobactam is…

A

Primarily active against gram-negative bacteria

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47
Q

Monobactam indications

A

Used for moderately severe systemic infections and UTI’s

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48
Q

Monobactam MOA

A

-Bactericidal action
-Inhibits bacteria cell wall synthesis by infiltrating the cell and binding to proteins making it unstable and breaking it down

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49
Q

Carbapenem general information

A

-Broadest antibacterial action of any antibiotics
-Potent & heavy hitting antibiotics
-Immune to the effects of B-lactamase

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50
Q

Carbapenem is often…

A

Reserved for complicated body cavity and connective tissue infections in acutely ill hospitalized patients

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51
Q

Carbapenam is a…

A

Broad spectrum antibacterial activity against gram-positive & gram-negative bacteria

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52
Q

Carbapenem indications

A

-Bone, joint, skin, and soft tissue infections; bacterial endocarditis, intra-abdominal infections, pneumonias, UTI’s, pelvic infections and bacterial septicemia

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53
Q

Meropenem is the…

A

Only drug effective for bacterial meningitis

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54
Q

Carbapenem MOA

A

-Bactericidal action
-Inhibits bacteria cell wall synthesis by infiltrating the cell and binding to proteins making it unstable and breaking it down

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55
Q

Carbapenem adverse effects

A

-Seizures and confusion**
-GI upset & rash

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56
Q

Carbapenem drug interactions

A

Cyclosporin, ganciclovir & probenecid may cause CNS adverse effects (seizures/confusion)

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57
Q

Carbapenem contraindications

A

Pregnancy, hx of renal disease, geriatrics and seizures disorders

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58
Q

Carbapenem nursing implications

A

Monitor skin, bowel, therapeutic response and CNS function
-Re-evaluate lab work

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59
Q

Tetracycline general information

A

Most commonly given PO in a tab/cap

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60
Q

Tetracycline indications

A

-Wide range antibiotic (Both Gram +/-)
-Acne, chlamydia, pneumonia’s, UTI’s and skin infections

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61
Q

Tetracycline MOA

A

-Bacteriostatic
-Protein synthesis inhibitor

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62
Q

Tetracycline adverse effects

A

-Discolouration of teeth in fetuses and children and disrupted fetal skeletal development if taken during pregnancy
-Photosensitivity (sunburn), diarrhea, yeast Infection and aUrine colour

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63
Q

Tetracycline contraindications

A

-Pregnancy/breastfeeding
-Children under 8 years old
-When taken with calcium & iron

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64
Q

Tetracycline drug interactions

A

Anticoagulants, bactericidal antibiotics & oral contraceptives

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65
Q

Tetracycline nursing implications

A

-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

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66
Q

Aminoglycoside general information

A

-Very Potent
-Not given orally d/t poor absorption
-Usually given with Beta-Lactams/ Vancomycin to provide a synergistic effect

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67
Q

Aminoglycoside fights…

A

Mostly gram negative & some gram positive

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68
Q

Aminoglycoside indications

A

Serious infections, GI/GU infections, endocarditis and respiratory tract infections

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69
Q

Aminoglycoside MOA

A

Bactericidal, protein synthesis inhibitor and disrupts the cell membrane

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70
Q

Aminoglycoside adverse effects

A

Ototoxicity, nephrotoxicity and drug toxicity

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71
Q

Aminoglycoside contraindications

A

Renal impairment and pregant or breastfeeding women

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72
Q

Aminoglycoside drug interactions

A

Loop diuretics and oral anticoagulants

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73
Q

Aminoglycoside implications

A

-Renal Assessment
-Neurological assessment; dizziness, vertigo, tinnitus, roaring in ears and hearing loss
-Therapeutic drug monitoring

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74
Q

Fluoroquinolones general information

A

Very potent

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75
Q

Fluoroquinolones are for…

A

Mostly gram negative and some gram positive

76
Q

Fluoroquinolone indications

A

Complicated UTI’s and respiratory tract infections
-Skin, GI, bone, and joint infections

77
Q

Fluoroquinolone MOA

A

-Bactericidal
-Alter DNA of bacteria

78
Q

Fluoroquinolone adverse effects

A

Central nervous, skin, GI, elevated ALT/AST, and prolonged QT interval

79
Q

Fluoroquinolone contraindications

A

Cardiac dysrhythmias

80
Q

Fluoroquinolone drug interactions

A

Antacids, anticoagulants, calcium/magnesium, bronchodilators and iron/zinc preparations

81
Q

Fluoroquinolone nursing implications

A

-May be taken with meals (except dairy alone)
-Reduce caffeine if excessive cardiac or CNS stimulation occurs
-Maintain hydration/urine output

82
Q

Clindamycin general information

A

Derived from old antibiotic lincomycin

83
Q

Clindamycin is for…

A

Both gram + & -

84
Q

Clindamycin indications

A

Chronic bone infections, UTI’s, intra-abdominal infections, anthrax, endocaditis and malaria

85
Q

Clindamycin MOA

A

-Can be both bactericidal/static based on the dose
-Protein synthesis inhibitor

86
Q

Clindamycin adverse effects

A

GI upset, joint pain, thrush and yeast infection

87
Q

Clindamycin contraindications/drug interactions

A

-Ulcerative colitis
-Neuromuscular drugs

88
Q

Clindamycin nursing implication

A

-May be taken with food
-Bowel assessment

89
Q

Metronidazole general information

A

-Flagyl
-Class: Nitroimidazole

90
Q

Metronidazole indications

A

Intra-abdominal and gynaecological infections

91
Q

Metronidazole MOA

A

-Bactericidal
-Alter DNA of bacteria

92
Q

Metronidazole adverse effects

A

GI, nasal congestion, neutropenia and thrombocytopenia

93
Q

Metronidazole contraindications

A

Breastfeeding mother

94
Q

Metronidazole drug interactions

A

Antidepressants, ETOH, Li+, benzodiazepine, cyclosporin and CCBs

95
Q

Metronidazole nursing implications

A

-Keep hydrated
-Take on full stomach to avoid digestive upset

96
Q

Vancomycin general information

A

Treatment of choice for MRSA

97
Q

Vancomycin indications

A

MRSA, C. diff, bone and bloodstream infections

98
Q

Vancomycin MOA

A

-Bactericidal
-Destroys bacteria cell wall causing cell death

99
Q

Vancomycin adverse effects

A

Ototoxicity, nephrotoxicity, ‘Red Man Syndrome’ and neutropenia

100
Q

Vancomycin contraindications

A

-Hearing condition and kidney dysfunction
-Take caution with neonates/older adults

101
Q

Vancomycin drug interactions

A

Neuromuscular blockers

102
Q

Vancomycin nursing implications

A

Therapeutic drug dose, stay hydrated & monitor U/O

103
Q

Definition of inflammation

A

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
Q

Anti-inflammatory medication MOA

A

Blocks the arachidonic acid (repair&regrow) pathway

105
Q

Anti-inflammatory medications

A

Nonsteroidal & corticosteroids

106
Q

Salicylates

A

Aspirin & diflunisal

107
Q

Acetic acid derivatives

A

-Diclofenac Na+, indomethacin suindac, etodolac, ketorolac and mefenamic acid
-Things that end in “ic” OR “ac” (puts the “ace” in acetic acid)

108
Q

COX-2 Inhibitors

A

Celecoxib

109
Q

Enolic acid derivatives

A

Nabumentone, meloxicam and piroxicam

110
Q

Propionic acid derivatives

A

-Flurbiprofen, ibuprofen, ketoprofen, naproxen and oxaprozin tioprofenic
-Things that have “pro” in them

111
Q

NSAID

A

Large group of medications accounting for over 4% of all prescriptions in Canada

112
Q

4 primary properties

A

Analgesics, anti-inflammatory, anti-arthritic and antipyretic activities

113
Q

NSAIDS are used for…

A

Mild-moderate headaches, myalgia, neuralgia and arthraigia, alleviation of post operative pain and inhibition of platelet aggregation

114
Q

Arthritic disorders such as

A

Ankylosing spondylitis, and tx of gout & hyperuricemia

115
Q

Recommended NSAID for ankylosing spondylitis

A

Indomethacin, naproxen and flurbiprofen

116
Q

Recomended NSAID diabetic neuropathy

A

Sulindac

117
Q

Recommended NSAID for dysmenorrhea

A

Fenamates, naproxen and ibuprofen

118
Q

Recommended NSAID for gout

A

Indomethacin, naproxen and sulindac

119
Q

Recommended NSAID for headaches

A

Aspirin, ibuprofen and naproxen

120
Q

Recommended NSAID for hepatotoxicity

A

Naproxen, ibuprofen, piroxicam and fenamates

121
Q

Recommended NSAID for a hx of aspirin or NSAID allergy

A

Avoid NSAIDs if possible; if deemed necessary, consider a nonacetylated salicylate

122
Q

Recommended NSAID for HTN

A

Sulindac, nonacetylated salicylate, ibuprofen and etodolac

123
Q

Recommended NSAID for OA

A

Diclofenac, oxaprozin and indomethacin

124
Q

Recommended NSAID for pt at risk for GI toxicity

A

All COX-2 inhibitors

125
Q

Recommended NSAID for pt at risk for nephrotoxicity

A

Sulindac, nonacetylated salicylate, nabumetone, etodolac, diclofenac and oxaprozin

126
Q

Recommended NSAID for warfarin therapy

A

Sulindac, naproxen, ibuprofen and oxaprozin

127
Q

Contraindications of NSAID use

A

-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
Q

Anti-inlammatory adverse effects on CV

A

Moderate to severe noncardiogenic pulmonary edema

129
Q

Anti-inflammatory adverse effects on GI

A

Dyspepsia, heartburn, epigastric distress, N/V, anorexia, abd pain, GIB, mucosal lesions

130
Q

Anti-inflammatory hematological adverse effects

A

aHemostasis through effects on platelet function

131
Q

Anti-inflammatory hepatic adverse effects

A

Acute reversible hepatotoxicity

132
Q

Anti-inflammatory adverse effects on the renal system

A

Reduction in CrCl and tubular necrosis w kidney failure

133
Q

Other anti-inflammatory adverse effects

A

Skin eruption, sensitivity reactions, tinnitus and hearing loss

134
Q

Anti-inflammatory interaction with ETOH

A

Additive effect that may cause a GIB

135
Q

Anti-inflammatory interaction with anticoagulants

A

Platelet inhibition and hypoprothrombinemia which increases bleeding tendencies

136
Q

Anti-inflammatory interaction with antihyperglycemic drugs

A

Increased antihyperglycemic response to sulfoneureas which reduces BG

137
Q

Antiinflammatory interaction with SA and other salicylates with NSAIDs

A

Reduces NSAID absorption and has additive GI toxicities which increase GI toxicity with therapeutic advantage

138
Q

Anti-inflammatory interaction with corticosteroids and other ulcerogenic drugs

A

Additive toxicities and increased ulcerogenic effect

139
Q

Anti-inflammatory interaction with cyclosporines

A

Inhibits kidney prostaglandin synthesis and increases the nephrotoxic effects of cyclosporine

140
Q

Anti-inflammatory interactions with hypotensive drugs & diuretics

A

Inhibits prostaglandin synthesis and reduces hypotensive/diuretic effects

141
Q

Anti-inflammatory interaction with phenytoin

A

Inhibit phenytoin metabolism and increases its serum levels

142
Q

Anti-inflammatory interactions with protein-bound drugs

A

Compete for binding and more pronounced drug actions

143
Q

Anti-inflammatory interactions with uricosurics

A

Antagonistic effect that reduces uric acid secretion

144
Q

NSAID overdose S&S

A

Lethargy, drowsiness, confusion, disorientation, paraesthesia, numbness, aggression & seizures

145
Q

GI toxicities + anti-inflammatories

A

N/V & GIB

146
Q

Adverse effects of anti-inflammatories

A

GI toxicity, headache, dizziness, cerebral edema, cardiac arrest & death

147
Q

CVD risk + NSAIDs

A

-May increase the risk of thrombosis
-NSAIDs are contraindicated in the perioerative CABG setting

148
Q

GI risk + NSAIDs

A

Elderly pt are at greater risk

149
Q

Anti-inflammatory meds + lab values to monitor

A

-Hemoglobin, hematocrit, hyperkalemia, hyponatremia, AST & ALT (hepatotoxicity is rare)

150
Q

Specific conditions r/t NSAIDs

A

Gout & Reye’s syndrome

151
Q

Gout

A

-Elevated uric acid crystals in tissues/joints

152
Q

Allopurinol + gout

A

Prevents uric acid production

153
Q

Colchicine + gout

A

Reduces the inflammatory response to deposits of uric crystals; used in acute tx

154
Q

Reye’s syndrome

A

Aspirin is contraindicated in children with viral illnesses and may result in encephalopathy or liver damage

155
Q

S&S of Reye’s syndrome

A

aLOC, coma, flaccid paralysis, loss of deep tendon reflexes, seizures & vomiting

156
Q

Corticosteroids

A

Mineralocorticoids & glucocorticoids

157
Q

Mineralocorticoids

A

Aldosterone; regulates Na+, influences K+ & causes metabolic alkalosis

158
Q

Glucocorticoids

A

-Also have anti-inflammatory properties
-Systemic or topical glucocorticoids are available in short, intermediate and long acting forms

159
Q

All naturally occuring corticosteroids in the body are…

A

Available in exogenous form

160
Q

Systemic glucocorticoids

A

-Prednisone; oral and intermediate acting
-Solu-cortef: Hydrocortison Na+, IV form

161
Q

Corticosteroids MOA

A

r/t the synthesis of specific proteins & indirectly modify enzyme activity

162
Q

Mineralocorticoid aldosterone

A

Effect fluid & electrolyte balance on the distal kidney tubule

163
Q

Glucocorticoid hydrocortisone

A

Inhibits inflammatory & immune response

164
Q

Corticosteroids control the…

A

Inflammatory response by stabilizing cell membranes

165
Q

Corticosteroid indications (1)

A

Allergies, bacterial meningitis, cancers, cerebral edema, chronic respiratory illness, skin disease and endocrine disorders

166
Q

Corticosteroid indications (2)

A

-GI, rheumatic & hematological disorders
-Nonrheumatic inflammation, nephrotic syndrome, organ transplant, leukemias and lymphomas

167
Q

Corticosteroid contraindications

A

Cataracts, glaucoma, PUD, mental health concerns and DM

168
Q

Corticosteroid CV adverse effects

A

-HF, cardiac edema and HTN—all caused by electrolyte imbalances (hyperkalemia, hyponatremia)
-Impaired glucose tolerance, dysrhythmias, bradycardia, pulmonary edema, syncope and vasculitis

169
Q

Corticosteroid CNS adverse effects

A

Convulsions, vertigo, mood swings, nervousness, aggressive behaviours, psychotic symptoms, neuritis, peripheral neuropathy, paresthesia, arachnoiditis, meningitis and insomnia

170
Q

Corticosteroid endocrine system adverse effects

A

Growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, hypothalamic–pituitary–adrenal axis suppression, hirsutism, hypertrichosis and glycosuria

171
Q

Corticosteroid GI adverse effects

A

Peptic ulcers, pancreatitis, ulcerative esophagitis and abdominal distension

172
Q

Corticosteroid skin adverse effects

A

Fragile, dry, hyperpigmented, petechiae, ecchymosis, facial erythema, poor wound healing, urticaria, acne and stria

173
Q

Corticosteroid MSK adverse effects

A

Myopathy, atrophy, osteoporosis, osteonecrosis of femoral & humeral heads, pathological fracture and malaise

174
Q

Corticosteroid ocular adverse effects

A

IIOP, glaucoma & cataracts

175
Q

Corticosteroid “other” adverse effects

A

Weight gain, leukocytosis, opportunistic infections, hypokalemia and alkalosis

176
Q

Systemic corticosteroid interactions with non-potassium sparing diuretics

A

Hypocalcemia & hypokalemia

177
Q

Systemic corticosteroid interactions with aspirin & other NSAIDS

A

GI effects and gastric ulcer development

178
Q

Systemic corticosteroid interactions with cholinesterase drugs

A

Weakness with myasthenia gravis

179
Q

Systemic corticosteroid interactions with immunizing biologics

A

Inhibit immune response

180
Q

Systemic corticosteroid interactions with antidiabetic drugs

A

Elevated blood glucose

181
Q

Glucocorticoid pt teachings

A

-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
Q

Routes of corticosteroids

A

PO, IM, IV, intranassally & inhaled

183
Q

Corticosteroids cause…

A

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
Q

Do not give corticosteroids with…

A

Aspirin or other NSAIDS to minimize the risk of gastric irritation and possible gastric bleeding from compounding ulcerogenic effects

185
Q

Oral corticosteroids should be…

A

Given with milk or food to help minimize GI upset

186
Q

Monitor blank with corticosteroids

A

Therapeutic response and adverse effects including Cushing’s syndrome

488 (16 decks)

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