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Exam 3 Flashcards

1
Q

Bactericidal

A

Kill bacteria

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2
Q

Bacteriostatic

A

Inhibits bacterial growth

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3
Q

Culture and sensitivity

A

Causative microorganism and vulerabikity to specific antibiotics;Obtained first before start antibiotics, separate stick and chlorahexidine cleaner for cultures

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4
Q

Resistance

A

Difficult to treat, overuse and or not taking full course

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5
Q

Superinfection

A

Undergo tx with antibiotic and get another infection, i.e. candidiasis - oral or vaginal thrush

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6
Q

Pt teaching for antibiotics

A

Report diarrhea, s/s of rxn, call 911 if throat swells, take with food to decrease GI upset, take FULL regimen, increase fluid intake , wear medic alert ID for cephalosporin or penicillin allergies , barrier method for birth control, antacids 2 hr before or 1 hr after abx

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7
Q

General nursing interventions for antibiotics

A

Monitor for rxns, diarrhea, C&S before any abx, RFT and LFT, superinfection , check compatibility, renal toxicity and ototoxicity

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8
Q

How do you recognize penicillins?

A

-cillin

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9
Q

Pt teaching for penicillins

A

Increase your fluid intake, take with Food to decrease GI upset, allergic rxn s/s, take the FULL regiment, wear medic alert ID if penicilllin or cephalosporin allergy, use alternative birth control methods

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10
Q

Drug interactions with penicillins

A

Aminoglycosides-NONCOMPATIBLE
Oral contraceptives are less effective
Antacids decrease absorption of penicillins

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11
Q

Mechanism of action for penicillins

A

Inhibit the synthesis of bacterial cell walls

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12
Q

Nursing interventions for penicillins

A

-Aware of allergies to penicillins AND Cephalosporin
-Monitor for allergic rxn (15-30 min minimum)after 1st dose
-C&S before any abx
-RFT and LFT (BUN, creatinine, ALT ,AST)
-Monitor for bleeding
-Monitor for superinfections
-Check compatibility
-Report abnormal labs

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13
Q

How to recognize cephalosporins

A

Cef- or ceph-

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14
Q

Nursing interventions for cephalosporins

A

Allergies to penicillins?
C&S
RFT and LFT
Superinfection
Bleeding
Large muscles for IM injection (pain)- ventrogluteal
Report abnormal
Some can cause disulfiram rxns- hang over like s/s
Infused over at least 30 min

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15
Q

Pt teaching for cephalosporins

A

Avoid alcohol (disulfiram- like rxn)
Oral contraceptives-less effective
Take a probiotic
Take with food
Increase fluids
Report diarrhea

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16
Q

Contraindications for cephalosporins

A

Calcium containing products, penicillin,cephalosporin allergy, decrease LF or RF

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17
Q

Vancomycin nursing interventions

A

Monitor peak and trough levels, C&S first, administer IV over 60 min minimum
Monitor for hearing changes
Monitor for Red Man syndrome
Monitor infusion site
RFT
Monitor for superinfection

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18
Q

Indications for vancomycin

A

Only effective against gram positive organisms; tx for MRSA and C. Diff (orally tx, not absorbed in GI tract)

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19
Q

Adverse effects for vancomycin

A

Red-Man syndrome (pushed too fast IV), ototoxicity(dose related), nephrotoxicity, Steven-Johnson syndrome(painful pink/red spots that may blister- eyes mouth genitals) , IV site pain, thrombophlebitis, drug interactions with ototoxic meds

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20
Q

How to recognize macrolides

A

-omycin or thromycin ;
Macrolides= “throw mice”

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21
Q

Pt teaching for macrolides

A

Report diarrhea, take a probiotic (prevent C.Diff), full regimen!! Antacids 2 hr before 1 hr after, food 1 hr b4 2 hr after, report and monitor for hearing losses and superinfection, avoid sun, birth control barrier methods, allergic rxn s/s

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22
Q

Adverse effects to report- Clindamycin

A

Diarrhea, fatal colitis=black box warning!

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23
Q

Black box warning for clindamycin

A

Severe and possibly fatal colitis

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24
Q

When do you obtain peak and trough levels for aminoglycosides

A

Thirty min before next dose (results before next dose) and 30 min after administration

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25
Adverse effects for aminoglycosides
Nephrotoxicity, ototoxicity, neurotoxicity, photosensitivity, muscle cramps, pruritus, hypersensitivity rxns, tremors, N/V, seizures and encephalopathy
26
Nursing interventions for aminoglycosides
C&S first, renal function baseline and monitor, if altered=decrease dose; monitor for ototoxicity; superinfection monitor, peak and trough monitor
27
Pt teaching for aminoglycosides
Report hearing changes, keep track of amt and appearance of urine, report diarrhea, avoid sun(phototoxicity) allergic rxns-report s/s monitor peak and trough levels
28
How do you recognize tetracyclines
-cycline
29
Drug-food interactions with tetracyclines
Food-impairs absorption (except doxy and mino)- 2 hrs after meals and 1 hr before Dairy-avoid! 1 hr before dairy Antacids, Magnesium, iron, calcium(tetracycline=less effective) Oral contraceptives= less effective
30
Side effects/adverse effects tetracyclines
Photosensitivity, teeth staining(preg ppl=baby stained teeth), GI distress, superinfection, hepatotoxicity, nephorotoxicity
31
How do you recognize fluoroquinolones
-oxacin
32
Nursing interventions for fluoroquinolones
C&S, infuse at least over 60 min (if not 90)-never less, take with food, increase fluids to 2 L/day, avoid caffeine, superinfection monitor, take probiotic, avoid sun, monitor kidney function, tendon pain (swelling, redness, decrease strenuous exercise), backup birth control needed
33
Adverse effects of fluoroquinolones
Photosensitivity, N/V/D, Achilles tendon rupture, superinfection, crystalluria, hypersensitivity rxns, arthropathy, dizziness, headache, peripheral neuropathy, arrhythmia, seizure
34
Sulfonamides
oral, IV, topical, ophthalmic; i.e. trimethoprim-sulfamethoxazole (TMP-SMZ); pregnancy category D
35
Nursing interventions for sulfonamides
Fluids- 2L Q day, output and KF, CBC, crystalluria monitor, S/S infection, bleeding, anemia, avoid sun, superinfection, food 1 hr before/2hr after, Rash/flu-like symptoms-report Barrier birth C needed
36
Pt teaching for sulfonamides
Barrier method needed Avoid sun Report rash/flu-like s/s Food- 1 hr before 2 hr after
37
Anaphylaxis
Call 911, rapid response team
38
Prophylaxis
Prevent infection
39
Host factors for bacteria
Immune system, site of infection, age, pregnancy , allergies, combination therapy
40
T/F abx are effective for a cold/virus
False
41
What should you monitor for when a pt is on an abx
Diarrhea- Clostridium Difficile (C-Diff!), abx kills good gut bacteria and bad bacteria takes over causing C Diff
42
S/S of hepatotoxicity
Abd pain, jaundice, flank pain, N/V, dark urine, anorexia
43
What type of drugs are penicillins, cephalosporins, carbapenems, and monobactams (aztreonam)?
Beta lactams
44
What type of drug is vancomycin?
Glycopeptide
45
Mild allergic reaction
Itching, hives, rash; stop the medication and call the provider
46
Anaphylactic shock s/s
Laryngeal edema, dyspnea, bronchospasms, cardiac arrest
47
Tx for anaphylactic shock
Epinephrine and albuterol
48
Tx for mild reactions
Antihistamine
49
What do Beta lactams do to bacteria?
Inhibit the synthesis of the bacterial cell wall
50
Naturally occurring penicillins are made by ______.
Mold
51
Natural and penicillinase are __________ ___________, which are gram ____________.
Narrow spectrum; positive
52
Aminopenicillins are ______________ (some gram-________ activity and penicillinase sensitive)
Broad spectrum; negative
53
Extended spectrum abx are active against :
Pseudomonas
54
Extended spectrum abx are relatively ineffective against:
Gram-positive organisms
55
How are penicillins exerted?
Active tubular secretion
56
Side/adverse effects of penicillins
Hypersensitivity, superinfection, N/V/D, nephropathy, CNS toxicity, Hepatic injury
57
What are the types of hypersensitivities with penicillins?
Immediate- 2-30 min, accelerated 1-72 hrs, late days-weeks
58
How many generations are there with cephalosporins
Four
59
First generation cephalosporins are _____ spectrum, similar to ______ - spectrum ______ and sensitive to B lactamases
Narrow, broad
60
Drug interactions for cephalosporins
Calcium-containing products-non compatible Alcohol causes disulfiram rxn Antacids decrease absorption Oral contraceptives are less effective Probenecid decreases excretion of cephalosporins Nephrotoxic drugs (aminoglycosides) can cause nephrotoxicity
61
What cephalosporin must be given ventrogluteal IM?
Ceftriaxone or Rocephin
62
What is required monitoring for vancomycin?
Peak and trough
63
How long must vancomycin be given over?
60 min minimum
64
Red-Man syndrome
When vancomycin is given too quickly; redness in face, neck, chest, tacycardia, hypotension ; not allergic rxn- stop infusion, give diphenhydramine, and when s/s resolve, start infusion at a slower rate
65
Stevens-Johnson syndrome
Fever, flu-like symptoms, rash=blue/purple (face first), dysphagia, dysuria
66
What cephalosporins have anti-vitamin K effects? What can they cause?
Ceftriaxone(Rocephin) cefotetan(Cefotan)
67
What is pseudomonas membranous colitis
C. Diff/ clostridium difficile
68
Second generation cephalosporins have an increased activity towards ________ __________ organisms
Gram negative
69
Third generation cephalosporins are even ________ in spectrum and are more ______ to B-lactamase
Broader, resistant
70
Fourth generation cephalosporins work for _________________ and ______________ activity
Gram-postive and gram-negative
71
What routes can cephalosporins be given?
PO, IM, IV
72
Cephalosporins have a cross allergy with:
Penicillins
73
Side/adverse effects of cephalosporins
GI distress (N/V/D), hypersensitivity reactions, bleeding, superinfections, pain with IM injection
74
How do you recognize aminoglycosides?
-micin, -mycin except for amikacin
75
What are aminoglycosides?
Broad spectrum abx that are poorly absorbed orally; non compatible with penicillin, but typically given together in separate tubing.
76
What do aminoglycosides require for administration?
Peak and trough levels and monitoring- small margin of safety with a narrow therapeutic index
77
What type of drug is an aminoglycoside?
Protein synthesis inhibitor, requires binding to intracellular protein (ribosomal subunit) and needs to gain entry into the cell
78
Gentamicin
Aminoglycoside
79
Drug interactions with gentamicin
Penicillin, ototoxic meds (i.e. loop diuretics), nephrotoxic meds (ampoteracin B and vancomycin), oral contraceptives- less effective Antacids= decrease effect
80
S/S of ototoxicity?
Tinnitus, balance issues,hearing loss, (baseline hearing needed)
81
S/S of renal toxicity?
Hematuria, proteinuria, decreased output, cloudy urine; baseline I&O needed
82
How do you measure a baby’s I&O?
Log intake and weigh diapers for output
83
Tetracyclines
Similar to amingoglycosides, broad-spectrum abx, useful in tx for rickettsial disease, chlamydial disease, cholera, Lyme disease, mycoplasma pneumonia
84
Routes for tetracyclines
oral, IM (painful and rarely used), IV
85
Pregnancy category for Tetracyclines
D- contraindicated
86
Interventions/pt teaching tetracyclines
C&S, food 1 hr before 2 hr after, Kidney and Liver, avoid sun, superinfection monitor, probiotic (take), avoid milk, iron, magnesium, antacids, calcium Expiration dates= CNS toxicity
87
Empiric therapy
Abx started before C&S results
88
Selective toxicity
Kill only microbe and not host cells
89
Beta lactamase
Enzyme in bacteria that eats through beta lactation rings in abx
90
What do macrolides treat?
Mycoplasma infections, pneumonia, legionnaires disease, chlamydial infections, diphtheria, pertussis, COPD pt with pneumonia
91
Side/adverse effects of macrolides
GI effects (N/V/D, cramping, anorexia), hypersensitivity rxn, phototoxicity, superinfection, ototoxicity(high doses)
92
When should macrolides be cautiously used?
In pt with liver disease or dysfunction
93
Drug interactions for macrolides
Antacids=inhibit absorption Oral contraceptives=less effective Digoxin(HR), cyclosporine(immunosuppressive), and warfarin(bleeding)= increase effects of macrolides Penicillins and clindamycin decrease effect of macrolides
94
Lincosamides
Only used if known sensitivity , activity against anaerobes- can penetrate bone; C.Diff =resistant, allergy to PCN? Black box warning: severe and possible fatal colitis!!!
95
Clindamycin routes
IV, PO, IM
96
Side effects/adverse reactions Clindamycin
Rash, N/V/D, phototoxicity, C. Diff (d/c at first sign of diarrhea)
97
Nursing interventions for Clindamycin
C&S first, full regimen unless diarrhea develops, take with food, take probiotic, report diarrhea, antacids inhibit absorption
98
Quinolones
Inhibit DNA replication, limited to tx for complicated infections, broad spectrum ; routes=PO and IV
99
Contraindications for fluoroquinolones
Less than 18 yo
100
Sulfonamides s/e and a/e
GI distress, superinfection(a), photosensitivity, crystalluria (a), blood dyscrasias(low RBC,WBC, and PLT= s/s anemia, infection, bleeding), Stevens-Johnson syndrome(a), hypersensitivity rxns(a)
101
Sulfonamides drug interactions
Oral contraceptives=less effective Antacids=inhibit absorption Oral hypoglycemics increase risk of hypoglycemia ACE inhibitors and Potassium-sparing diuretics increase K+(hyperkalemia) Warfarin (increases effect) Diogoxin and sulfonylurea (increases drug effects- K+ level, bleeding, Digoxin toxicity)
102
S/S of digoxin toxicity
Yellow/green halos, bradycardia, anorexia, N/V
103
Metronidazole drug type
Antiprotozoal, tx for vaginal trichomoniasis, giardiasis, and all forms of amebiasis, also tx for C.Diff and H. Pylori, PO and IV(C.Diff) route
104
S/e and a/e of metronidazole
Hypersensitivity rxns (a) GI upset N/V/D(S) Photosensitivity (S) Superinfection (a) Urine discoloration (s)- dark red/brown Metallic taste (S) Stevens-Johnson syndrome (a) Disulfiram-like rxn (a) Neurotoxicity/CNS toxicity(a)- seizures, ataxyia, dizziness, extremity weakness
105
Indications for metronidazole
Vaginal trichomoniasis, giardiasis, all forms of amebiasis, treat H. Pylori and C.Diff (anaerobic bacteria and several protozoan species)
106
Pt teaching for metronidazole
Dark brown/red urine=expected Avoid alcohol (Disulfiram rxn) Metallic taste=expected Avoid sun/wear protective clothing and sunscreen
107
Nitrofurantoin
Tx for UTI and cystitis only, oral, stays in kidneys
108
Nursing considerations/ pt teaching for nitrofurantoin
Increase fluid intake 2L q day prevent crystalluria Severe GI distress (anorexia, N/V/D, abd pain) Antacids- avoid Take with food Brown urine=expected Liquid can stain teeth
109
Indications for nitrofurantoin
UTI or cystitis
110
TB
Mycobacteria= slow growing and require prolonged tx Dx= acid-fast sputum culture Important for pt to take abx as prescribed, combination therapy= vital:4-5 drugs Test every 3-6 months after tx complete Evaluate with chest radiography, sputum tests, and no s/s of TB
111
Current TB tx
6-9 months of RIPE(rifampin, INH, pyrazinamide, ethambutol)
112
Latent TB
Positive PPD but no s/s= INH, rifapentine, rifampin for 6-9 months (RRI)
113
MDR TB( multi-drug resistant)
Multiple drug therapy for up to 24 months (15-24 months), INH and Rifampin
114
INH
First-line drugs- isoniazid; take on empty stomach, oral and IM; contraindicated in liver disease
115
INH pt teaching
Take B6 (pirodoxine), s/s hepatitis (abd pain, anorexia, jaundice, fatigue, nausea), regular LFTs Avoid alcohol and Tyramine, use barrier method for birth control
116
When on INH, what is neuropathy a sign of?
Low B6
117
Example of tyramine foods
Aged meats (salami, pepporoni), aged cheese, avacado, fig, bananas, fish , soy saucer
118
Rifampin Side effects
Orange urine (all fluids and feces), no contacts (stains), adverse=hepatotoxicity
119
What do all TB meds have in common?
Can cause hepatotoxicity, LFT must be done, contraindicated in liver disease, avoid alcohol
120
What areas do fungal infections occur?
Poorly vascularized areas that increase growth (skin, nails, hair); fungi are slow to grow and harder to kill than bacteria
121
Amphotericin B is a ___________________
Polyene Antifungal, drug of choice for systemic fungal infection; highly toxic (only for life threatening systemic infections) for serious disseminated yeast and fungal infections
122
Amphotericin B s/e and a/e
-Infusion rxn- test dose first, no rxn=premed w/ diphenhydramine and acetaminophen -Hypokalemia -Bone marrow suppression(leukopenia, decrease WBC, PLTs, H&H, baseline CBC monitor) -Thrombophlebitis -Nephrotoxicity (inc hydration, 1 L normal saline on day of infusion; I/O, BUN, creatinine, report dec output)
123
Amphotericin B nursing interventions
Labs- CBC , H&H I/O Infusion rxn Central line(ideally), filter tubing needed, IV pump(2-4 hours with 1 L fluid same day)

Pharmacology (12 decks)

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