DONE: Immune PHARMACOLOGY Flashcards
What are these drugs classified as? Penicillins Cephalosporins Aminoglycosides Tetracyclines Fluoroquinolones Macrolides
A: antibacterial drugs/anti-infectives
It is important that your pt is receiving the right antibiotic and that it’s effective against whatever type of infection that they have going on or that it will prevent whatever we want it to prevent because some of these are given ________
A prophylactically
It’s important to know if your pt has _____ if they have ____ to a certain class of anti-infectives sometimes there are cross ____ with other classes that are closely related
A: allergies
Note: same answers for all blanks
You ___ get the cultural and sensitivity so collect the specimen before you begin the antibiotic or it can alter your result; you don’t have to ___to get the results but you do have to collect the specimen
A: MUST
Wait
Note: IMPORTANT
It kills the bacteria and it does that by inhibiting cell wall synthesis
A: bactericidal
Most effective against fast growing bacteria they are more susceptible to this
Partially metabolized in the liver
Mostly excreted in the urine
A: penicillins
If you have somebody with liver and kidney issues you are going to have to use caution with?
A: penicillins
Abbreviation: PCN and is commonly used for what medication?
A: penicillins
What are the 4 types of penicillins?
A: Aminopenicillins, Extended-spectrum, Natural, and Penicillinase-resistant
These are very common, old drugs so it’s really cheap
A: Aminopenicillins: amoxicillin (Amoxil), amoxicillin/clavulanate (Augmentin, Augmentin XR)
This type of anti-infective is effective against more bacteria
A: Extended-spectrum
An enzyme that is located on the penicillin and some bacteria is resistant to that enzyme so they would be resistant to the other penicillins
A: Penicillinase-resistant
Medication we would use if a patient is Penicillinase resistant
A: dicloxacillin (Dynapen), nafcillin, and oxacillin
Penicillins are effective against what types of bacteria?
A: Gram-positive cocci and bacilli Some gram-negative cocci, some anaerobes Aminopenicillins are used for enterococcal infection Gonorrhea Staphylococci
Up to 10% cross sensitivity so ppl who have an allergy to ____ might also have an allergy to _____; no one is ever allergic to a medication the first time they have it; an allergy is an immune system response and for your immune system to react to something it has to be exposed to it first and identify it as an invader and mount a defense against it so first dose is not going to get an allergic reaction any dose after that can.
A: cephalosporin
Penicillin
End in “cillin”
Nausea, vomiting, diarrhea, epigastric distress
Rash and it’s an allergic reaction and we will talk about that in a couple of seconds
Pain at IM site, thrombophlebitis at IV site it’s an irritating medication
Resistant bacterial and fungal super infections
Anaphylaxis
These adverse reactions are for what type of medication?
A: penicillin
If you receive penicillin then they should watch you for about ____ afterwards to see if you are going to have an anaphylactic reaction
A: 15-20 mins
If giving penicillin at the same time as an aminoglycoside it May decrease effectiveness of aminoglycosides
May diminish effectiveness of oral contraceptives, so you get strep throat, take penicillin and 9 months later have a baby
Extended spectrum penicillins with other PCNs may inhibit platelet aggregation so there you are having a risk for bleeding
A: Penicillin interactions
Probenecid (anti-gout medication) decreases renal excretion of PCN so again we would have to be cautious
Used with clavulanate or sulbactam enhances resistance against those bacteria that are resistant to Penicillinase; produces beta lactamase (which inactivates PCN)
Tetracyclines may decrease effectiveness so here you’ve got 3 antibiotic classifications on this 1 slide penicillin, amino glycosides, and tetracyclines and if you are giving those together you are not going to get the full effect so it’s really important to know and watch for that
A: Penicillin interactions
Directions for taking: include drug name, dosage, frequency, duration, possible adverse reactions; Take complete course of antibiotics; Advise patients on oral contraceptives to use another method; Precautions re: food, other meds; Signs of superinfection
A: general nursing responsibilities: Patient Education
Note: General nursing responsibilities apply to all classes of antibiotics
Watch for s/sx of allergic reaction; Anaphylaxis: rash, pruritus, laryngeal edema, wheezing and this will happen within the first 15 mins after taking it; Keep epinephrine, anti-histamine, and resuscitation equipment close by; Instruct the pt to avoid acidic or carbonated beverages if taking it orally because that can decrease drug absorption; general nursing responsibilities
A: Penicillin: Nursing Responsibilities
Begins with “cef” or “ceph”
Bactericidal; Does NOT kill fungi or viruses
Metabolism varies by drug but they are excreted primarily in the urine and you have to be sure that you have good renal function
A: cephalosporins
There are 4 generations of cephalosporins: 4th generation cephalosporins are more effective against ____and 1st generation is more effective against ___; least effective ____ at 4 and getting more and more until they are most effective at generation 1 and with ____ they are least effective with the 1st generation and more effective with the 4th generation
A: gram negative (4 to 1) gram positive (1 to 4) gram positive gram negative Note: other than that gram negative, gram positive there is really no reason that you have to be aware of which generation it is;
I want to point out in the 1st generation ___ is the medication that you see given prophylactically in the peri-operative period to prevent infection
A: Ancef
Gram-positive and gram-negative bacterial infections and that would be a reason a physician would order one or another generation
Gram-positive and gram-negative cocci infections
Some gram-negative bacilli infections
A: Cephalosporins: Contraindications
Nausea, vomiting, diarrhea (not allergic reactions) so you will see how that might not be a good thing with someone with colitis
Rash – allergic reaction
Anaphylaxis and remember that is an exaggerated allergic reaction
Pain at IM site, phlebitis at IV site-there can be irritation at the site
Pseudomembranous colitis can develop as a result of being on this medication and this is something that you know as C-diff
if somebody develops a rash or hives do not give them this medication; you need to stop it and notify the physician
A: Cephalosporins: Adverse Reactions
If also on aminoglycosides they are not compatible you have to use separate IV site and that is very important because we don’t want them mixing in the IV tubing and you can find that information in your drug guide under the compatibility chart
A: Cephalosporins: Interactions
____ is medication given to alcoholics that want to quit drinking so they take this medication and they get really sick if they drink so _____ will have a similar reaction
A: Disulfiram
Cephalosporins
End in “cin” Bactericidal Poor oral absorption, most given IV Not metabolized Excreted unchanged in urine What type of drug class is this?
A. aminoglycosides
_____ is NOT an aminoglycoside; ___ is in a category all by itself DO NOT GET THIS CONFUSED
A: Vancomycin
Vancomycin
Note: VERY IMPORTANT TO KNOW
Aerobic gram-negative bacilli and some gram-positive bacteria (some gram-positive are resistant)
Septicemia, postoperative pulmonary, intra-abdominal, and serious recurrent UTIs so we will use other medications for UTI’s unless they are serious and reoccurring, infections of bone, skin, soft tissue, and joints
Ammonia forming bacteria in gut of pt with hepatic encephalopathy
In conjunction with others: serious staph, serious pseudomonas aeruginosa infections, nosocomial pneumonia, TB, pelvic inflammatory disease, serious Klebsiella infections
This is used for serious infections and if they can use something else they will because the side effects of these drugs can be bad
What type of medication has these indications?
A: Aminoglycosides
Hypersensitivity as with any drug
Severe renal disease because it’s cleared there or excreted there
Pregnancy
Breast feeding
What medication has these contraindications?
A: Aminoglycosides
Must Use with caution for the following reasons for what medication?
Renal disease that is just renal disease not severe renal disease
Neuromuscular disorders such as Parkinson’s and myasthenia gravis
Heart failure
Elderly
Infants
A: Aminoglycosides
Note: We have to do that again because of the side effects
