EXAM 3 Antibiotics Flashcards
Penicillins
○ Assess for allergy to penicillin or cephalosporin, evaluate labs, check for superinfection
ANtibiotic
Allergy can develop anytime after the dose
○ Check CNS (lab culture) to discern the infective organism BEFORE therapy begins
ANTIBIOTICS
ALL Tend to cause hypersensitivity reactions (anaphylaxis, allergic reaction), ototoxicity,
hepatotoxicity, nephrotoxicity (ear, liver, kidney damage), and superinfection
phenazopyridine (Pyridium®)
- Numbs the GU system, relieves pain, burning sensation, and urgency to urinate
● Makes urine orange, headache, dizziness, GI distress, can cause orange skin pigmentation
Penicillin allergy vs sensitivity
Allergy is rash, hives, etc. If pt has a rash (total body reaction) they should probably stop the antibiotic
■ Sensitivity is GI distress. Does NOT require stopping meds for. Not serious enough
amoxicillin (Amoxil®)
Widely prescribed for outpatient wide(broad) spectrum antibiotic
■ Nausea, vomiting, diarrhea, rash, stomatitis, edema, insomnia, dysphagia,
superinfection, respiratory depression
Cephalosporins(Antibiotic)
○ Anaphylaxis, superinfection, headache, GI distress, C Diff, stevens-johnson syndrome
○ Starts with ceph or cef (ceftriaxone is an example)
○ DO NOT GIVE to anyone who has a penicillin allergy
■ Contraindicated in alcohol, no gout meds ○ GI sensitivity is NOT an allergy, it is a AE
Action of antibiotic?
Inhibition of bacterial cell wall synthesis
o Alteration of membrane permeability
o Inhibition of protein synthesis
o Inhibition of synthesis of bacterial RNA and DNA
o Interference with metabolism within the cell
Side effects of antibiotics?
Allergic reaction(anaphylaxis) Hypersensitivity Rash Puritis Hive Anaphylactic shock (falling hypotension, no BP) o Superinfection Secondary infection when normal flora is killed Usual sites Mouth, skin, respiratory tract Genitourinary tract, intestine Organ toxicity Ear, liver, kidney
Antibiotic drug resistance: Antibiotic misuse
Antibiotics taken unnecessarily For viral infections When no bacterial infection present Taking antibiotics incorrectly (skipping doses) Increases antibiotic resistance
Antibiotic Drug Resistance: Cross Resistance
Can occur between antibacterial drugs with similar actions
Antibiotic Drug resistance: Resistance to antibacterial?
Inherent resistance
Required resistance
Healthcare acquired infections?
MRSA
o VREF
o VRSA
Penicillins action?
Inhibit bacterial cell wall synthesis
Bacteriostatic and bactericidal
Depending upon the drug and dosage
Penicillins types?
Basic Penicillin
Broad spectrum penicillin’s – AMOXICILLIN (Amoxil ®)
Penicillinase resistant penicillin’s – Nafcillin
Extended spectrum penicillin’s – Piperacillin
Beta lactamase inhibitors(Penicillin)
This inhibits the beta lactamase inhibitors which makes the antibiotic more effective and extends antimicrobial effects
Not given alone
Combined with penicillinase sensitive penicillin
o Clavulanate o Sulbactam o Tazobactam
Penicillins Side Effects/ Adverse reactions?
Hyper sensitivity, anaphylaxis (rash, hives)
Superinfection
Tongue discoloration, stomatitis
GI Distress
GI sensitivity is not an allergic reaction to penicillin (diarrhea, vomiting, nausea)
Not a reason to stop medication
C.Diff associated diarrhea
Penicillins assessment?
Assess for allergy to penicillin or cephalosporin’s
Evaluate lab results, especially hepatic enzymes
Penicillins diagnosis?
Risk for infection
Nutrition, imbalanced: less than body requirements related to nausea and vomiting
Tetracycline Use?
Effective against gram positive and gram negative bacteria such as H. Pylori MRSA It Treats: o Acne o Anthrax o Plague o Gingivitis o Cholera o STI o Skin,urinary,and respiratory infections
Tetracycline action?
Inhibit protein synthesis
Broad spectrum
Bacterial resistant
Tetracycline Side Effects/Adverse Reactions? (Antibiotic)
Anaphylaxis, superinfection Photosensitivity, diplopia DISCOLORATION OF PERMANENT TEETH DO NOT GIVE TO CHILDREN YOUNGER THAN 8 YEARS OLD Stomatitis, glossitis, GI distress C.Diff associated diarrhea Ototoxicity Hepatotoxicity Nephrotoxicity Pancytopenia Stevens Johnson syndrome
Tetracycline Drug-Food interactions?
Milk products
Antacids
Tetracycline Drug-Drug Interactions?
Oral contraceptives Can interfere with:
Penicillin’s
Aminoglycosides
Tetracycline Assessment?
Assess vital signs and urine output
Check lab results, especially renal and liver function.
Vancomycin Drug Class?
Glycopeptide: strongest medication/antibiotic there is
For highly resistant bacteria
Vancomycin Action?
Inhibits cell wall synthesis
Effective against gram positive MRSA
Bactericidal
Vancomycin Use?
Respiratory, skin, and bone/joint infections
Bacteremia
Septicemia
Endocarditis
MRSA, C.diff associated diarrhea
o VANCOMYCIN ALWAYS NEEDS PEAK AND TROUGH LEVELS DRAWN
Vancomycin Side effects/ Adverse reactions? (Antibiotic)
Anaphylaxis, superinfection
Red neck or red man syndrome – to avoid this the medication must be given very slowly
Occurs when IV given too rapid
Severe hypotension
Red blotching of the face, neck, chest and extremities
GI distress and peripheral edema
Ototoxic and nephrotoxic
Highest nephrotoxic medication we have look for BUN and Creatine levels.
C. diff associated diarrhea
Stevens Johnson syndrome
Ciprofloxacin (Cipro) Drug Class?
Fluoroquinolone
Ciprofloxacin (Cipro) Action?
Interfere with enzyme DNA gyrase needed to synthesize bactericidal DNA
Effective against gram positive and gram negative S. pneumoniae, S. aureus, H.
influenza, P. aeruginosa, Salmonella and Shigella species
Bactericidal
Ciprofloxacin (Cipro) Use?
Anthrax – Cipro treats this
skin, soft tissue, bone/joint, gynecologic, intraabdominal, urinary and respiratory tract infections
Ciprofloxacin (Cipro) Side Effects/Adverse Reactions?
anaphylaxis, superinfection photosensitivity, eye damage, visual disturbances GI distress Dysgeusia Also known as parageusia which is a distortion of the sense of taste Tendinitis, Tendon rupture C.diff associated diarrhea Stevens Johnson syndrome
Ciprofloxacin (Cipro) Assessment?
Record vital signs along with intake and output
Ciprofloxacin (Cipro) Interventions?
Obtain specimen for Culture&Sputum Monitor I&Os Check lab values for renal function Advise patient to wear sun glasses, sunblock, and protective clothing when in the sun
Metronidazole (Flagyl®) Drug Class?
Nitroimidazoles
Metronidazole (Flagyl®) Action?
Disrupts DNA and protein synthesis in a bacteria and protozoa
Effective against H. Pylori, C. diff, Giardia, Gardnerella, Prevotell, Peptococcus
bacteria species, and Trichomonas vaginalis protozoa
Metronidazole (Flagyl®) Use?
Treats C. Diff diarrhea Amebiasis Giardiasis Trichomoniasis Bacterial vaginosis Acne Meningitis Gynecologic, skin, intraabdominal, and respiratory infections Kills ameba o Used for gynecological infections o Used for intravaginal STDs Also used adjunctively with other meds to help fight infection
Metronidazole (Flagyl®) Side Effects?Adverse reactions?
Anaphylaxis, superinfection
Headache, dizziness, insomnia, weakness
Dry mouth, dysgeusia, GI distress
Tongue/tooth discoloration
Peripheral neuropathy, seizures
Disulfiram – like reaction
Stevens Johnson syndrome
Mouth has metallic taste
1 sip of alcohol will produce projectile vomiting that doesn’t stop
Includes rubbing alcohol, and mouth wash (must be alcohol free)
Nursing Process: Penicillins: planning?
The patient’s infection will be controlled and ultimately eliminated.
Nursing Process: Penicillins: interventions?
Obtain a sample for lab culture and antibiotic
sensitivity testing to discern the infective organism
before antibiotic therapy is started.
➢ Monitor for evidence of superinfection, especially in
patients taking high doses of an antibiotic for a
prolonged time.
➢ Examine the patient for an allergic reaction,
especially after the first and second doses.
➢ Teach patient to take entire prescribed antibiotic.
Nursing Process: Cephalosporins: Assessment?
Assess for allergy to cephalosporins or penicillins.
Record vital signs and urine output.
◦ Evaluate lab results, especially renal and liver
function.
Nursing Process: Cephalosporins: Planning?
The patient’s infection will be controlled and ultimately eliminated.
Nursing Process: Cephalosporins: Interventions?
Culture the infected area before cephalosporin
therapy is started.
➢ Tell patient to report signs of superinfection.
➢ Instruct patient to take complete course of treatment. ➢ Observe for hypersensitivity reactions.
➢ Advise patient to take medication with food if gastric
irritation occurs.
Nursing Process: Tetracyclines: Planning?
The patient’s infection will be controlled and
ultimately eliminated.
Nursing Process: Tetracyclines: Interventions?
Obtain a sample for culture from infected area and
send to lab for C&S before antibiotic is begun.
➢ Monitor lab values for renal and hepatic function. ➢ Record vital signs and urine output.
➢ Inform female patients who are contemplating
pregnancy to avoid taking tetracycline because it can
cause discoloration of permanent teeth.
➢ Encourage patient to take entire course of antibiotic.
AMOXICILLIN/CLAVULANATE: Nursing Considerations
Shake suspension before administering each dose
Can be mixed with drinks
Give with meal to increase absorption and reduce GI effects
Give at equal intervals around to the clock to maintain blood levels
Discard unused suspension after 14 days
Nephrotoxic with high doses
