drug therapy to treat infection part 1

Question 1

infection occurs when

Answer 1

a microorganism invades a host, attaches to the host cell receptors, multiples, causing injury, immune system kicks in

Question 2

what can cause infection

Answer 2

bacteria, viruses, fungi, parasites

Question 3

systemic s/sx of infection

Answer 3

fever, chills, sweats, diffuse myalgia, tachycardia, fatigue, lethargy, tachypnea, hypotension (septic shock)

Question 4

local s/sx of infection

Answer 4

pain, erythema, edema, heat, exudate (leaking out of cut or coughing)

Question 5

labs you may seem with an infection

Answer 5

increase of WBC, cultures may be done

Question 6

factors that increase risk of infection

Answer 6

impaired skin integrity, impaired blood supply, neutropenia(low WBC), malnutrition, poor hygiene, suppression of normal bacterial flora, immune system suppression, DM, advanced age

Question 7

common bacteria

Answer 7

streptococcus pneumoniae (see with pneumonia), E. coli (UTIs/ through stool), staph aureus (skin infections & open wounds)

Question 8

general principles of antimicrobial therapy

Answer 8

1. match right drug to right bug
2. sometimes combination needed
3. account for host characteristics
4. benefit the individual and community
5. watch for improvement in s/sx once drugs started (24-36 hours after)
6. empiric (broad spectrum) vs definitive (narrow spectrum)

Question 9

if it is a virus/ viral infection you do not treat it with

Answer 9

antibiotics

Question 10

steps for an accurate diagnosis

Answer 10

1. obtain detailed exposure history
2. determine site of infection
3. define host characteristics
4. establish microbial diagnosis

Question 11

bactericidal

Answer 11

cause death and distruption of the bacterial cell

Question 12

bacteriostatic

Answer 12

inhibit bacterial replication- inhibit protein synthesis

Question 13

nursing process with infection

Answer 13

assess s/sx (vitals), assess allergies, adverse reactions, pt education

Question 14

pt education to prevent infections

Answer 14

hand hygiene, good diet, take all prescribed doses, even if they are feeling better, discard all discontinued drugs, side effects to expect, report allergic reactions

Question 15

common adverse reactions to anti infective therapy

Answer 15

kidney damage (can make crystals which is why need to increase fluids), neurotoxicity, hypersensitivity reactions, GI toxicity (pt throwing up), superinfection (wiped out normal flora)(yeast infection & cdiff)

Question 16

the nurse is preparing to administer an anti-infective agent to the pt. The nurse knows treatment is effective when which of the following occurs?

Answer 16

improvement of symptoms/ if this doesn’t happen we are worried about antibiotic resistance

Question 17

antibiotic classes: aminoglycosides

Answer 17

often used in combination therapy, narrow therapeutic index, very potent used for severe infections (sepsis, respiratory/ urinary tract infections, intra-abdominal infections)

Question 18

aminoglycosides adverse effects

Answer 18

black box warning: nephrotoxicity (s/sx: oliguria) & ototoxicity / CNS, renal, GI, cardiac effects

Question 19

aminoglycosides drugs

Answer 19

gentamicin (most common), neomycin, amikacin, tobramycin, streptomycin (GNATS)

Question 20

aminoglycosides contraindications

Answer 20

renal/ hepatic dysfunction, pre-existing hearing loss, active infection w/ herpes, myasthenia graves/ Parkinsonism, pregnancy (crosses placenta)

Question 21

aminoglycosides can be given with

Answer 21

penicillin but do not mix the medications, give penicillin 1 hour before or after aminoglycoside

Question 22

labs to check when giving aminoglycosides

Answer 22

urinalysis, BUN/ Creatinine

Question 23

peak times for aminoglycosides

Answer 23

at highest level of drugs effectiveness, draw 30 mins after drug is finished

Question 24

trough times for aminoglycosides

Answer 24

right before the drug is administered

Question 25

antibiotic classes: beta-lactam antibacterial agents

Answer 25

widely prescribed group of antibiotics, need intact beta-lactam ring for drugs to work, often combined with beta-lactamase inhibitor

Question 26

beta-lactamase inhibitors (stop bacterial enzymes from working, causing beta lactam to be effective)

Answer 26

bactrium (trimethoprim + sulfamethoxazole) & augmentin (amoxicillin + clavulante)

Question 27

subclasses of beta-lactam antibacterial agents

Answer 27

carbapenems, cephalosporins, monobactams, penicillin

Question 28

subclasses of beta-lactam antibacterial agents: carbapenems

Answer 28

broad spectrum, can treat many infection / used best in infections with bacteria that are resistant to other drugs

Question 29

carbapenem drugs

Answer 29

meropenem, ertapenem, imipenem

Question 30

adverse effects of Carbapenems

Answer 30

GI, CNS, renal effects, superinfection (c-diff) also associated with pseudomembranous ulcerative colitis (cause seizures)

Question 31

contraindications of carbapenems

Answer 31

kidney dysfunction, imflammatory bowel disease, no IM in severe shock or AV block (because IM contains lidocaine)

Question 32

notes for carbapenems

Answer 32

monitor EKG, if you give it IM, it contains lidocaine which is very painful

Question 33

subclasses of beta-lactam antibacterial agents: cephalosporins

Answer 33

broad spectrum, treats many infections

Question 34

adverse effects of cephalosporins

Answer 34

GI, renal effects / bleeding risks/ superinfection

Question 35

contraindications of cephalosporins

Answer 35

known allergies, renal dysfunction

Question 36

notes for when on cephalosporin

Answer 36

monitor CBC, monitor pt on anticoagulants

Question 37

subclasses of beta-lactam antibacterial agents: aztreonam

Answer 37

this is the only monobactam, given IV, IM and inhalation (inhalation for those with cystic fibrosis), gram negative bacteria (doesn't hurt normal bacteria in body as much)

Question 38

for cystic fibrosis pt, aztreonam inhalation steps

Answer 38

bronchodilator first, wait 30 mins, mucolytic second, wait 30 mins, aztreonam

Question 39

adverse reactions with aztreonam

Answer 39

rash, GI effects, localized thrombophlebitis (NO cross allergy with other beta lactams)

Question 40

subclasses of beta-lactam antibacterial agents: penicillins

Answer 40

most commonly prescribed, useful for many infections (dental procedures)

Question 41

penicillin drugs

Answer 41

penicillin, amoxicillin, ampicillin, piperacillin (with tazobactam)

Question 42

adverse effects of penicillins

Answer 42

hypersensitivity(skin rash, itching, angioedema), renal/ CNS (confusion, seizure, coma)/ GI effects, ***black box warning for penicillin G can lead to cardiac arrest***

Question 43

contraindications of penicillins

Answer 43

allergies to other beta lactams, renal dysfunction

Question 44

notes for penicillins

Answer 44

if given with aminoglycosides, DO NOT mix medications (give penicillin 1 hour before or after amino glycoside/ they will cancel each other out if given together)

Question 45

antibiotic classes: fluoroquinolones

Answer 45

used sparingly (very potent), treats complicated UTIs and systemic infections / has serious adverse effects/ resistances developed

Question 46

fluoroquinolones drugs

Answer 46

ciprofloxacin & levofloxacin

Question 47

adverse effects of fluoroquinolones

Answer 47

***black box warming for tendonitis, tendon rupture*** CNS, GI/ endocrine, skin, cardiac effects(irregular heart rhythm/ cause a prolonged QT) (wear sunscreen and long sleeves)

Question 48

contraindications for fluoroquinolones

Answer 48

allergy, renal dysfunction, myasthenia gravis (because it will cause weakness), not for pts over 18 years old, QT prolonging medications

Question 49

notes for fluoroquinolones

Answer 49

educate sunscreen and long sleeves, monitor EKG/QT, monitor blood glucose

Question 50

the pt is receiving ciproflaxcin. The nurse is most concerned if the pt complains of which of the following symptoms?

Answer 50

achilles tendon pain and redness

Question 51

the pt is receiving gentamicin. The nurse is most concerned with which of the following complaints?

Answer 51

tinnitus and difficulty hearing

Question 51

the pt is receiving gentamicin. The nurse is most concerned with which of the following complaints?

Answer 51

tinnitus and difficulty hearing