EXAM 3 Antibiotics

Question 1

Penicillins

Answer 1

○ 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

Question 2

ANTIBIOTICS

Answer 2

ALL Tend to cause hypersensitivity reactions (anaphylaxis, allergic reaction), ototoxicity,
hepatotoxicity, nephrotoxicity (ear, liver, kidney damage), and superinfection

Question 3

phenazopyridine (Pyridium®)

Answer 3

• Numbs the GU system, relieves pain, burning sensation, and urgency to urinate
  ● Makes urine orange, headache, dizziness, GI distress, can cause orange skin pigmentation

Question 4

Penicillin allergy vs sensitivity

Answer 4

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

Question 5

amoxicillin (Amoxil®)

Answer 5

Widely prescribed for outpatient wide(broad) spectrum antibiotic
■ Nausea, vomiting, diarrhea, rash, stomatitis, edema, insomnia, dysphagia,
superinfection, respiratory depression

Question 6

Cephalosporins(Antibiotic)

Answer 6

○ 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

Question 7

Action of antibiotic?

Answer 7

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

Question 8

Side effects of antibiotics?

Answer 8

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

Question 9

Antibiotic drug resistance: Antibiotic misuse

Answer 9

Antibiotics taken unnecessarily
 For viral infections
 When no bacterial infection present
 Taking antibiotics incorrectly (skipping doses)
 Increases antibiotic resistance

Question 10

Antibiotic Drug Resistance: Cross Resistance

Answer 10

Can occur between antibacterial drugs with similar actions

Question 11

Antibiotic Drug resistance: Resistance to antibacterial?

Answer 11

 Inherent resistance

 Required resistance

Question 12

Healthcare acquired infections?

Answer 12

MRSA
o VREF
o VRSA

Question 13

Penicillins action?

Answer 13

Inhibit bacterial cell wall synthesis
 Bacteriostatic and bactericidal
 Depending upon the drug and dosage

Question 14

Penicillins types?

Answer 14

Basic Penicillin
Broad spectrum penicillin’s – AMOXICILLIN (Amoxil ®)
 Penicillinase resistant penicillin’s – Nafcillin
 Extended spectrum penicillin’s – Piperacillin

Question 15

Beta lactamase inhibitors(Penicillin)

Answer 15

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

Question 16

Penicillins Side Effects/ Adverse reactions?

Answer 16

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

Question 17

Penicillins assessment?

Answer 17

Assess for allergy to penicillin or cephalosporin’s

 Evaluate lab results, especially hepatic enzymes

Question 18

Penicillins diagnosis?

Answer 18

Risk for infection

 Nutrition, imbalanced: less than body requirements related to nausea and vomiting

Question 19

Tetracycline Use?

Answer 19

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

Question 20

Tetracycline action?

Answer 20

Inhibit protein synthesis
 Broad spectrum
 Bacterial resistant

Question 21

Tetracycline Side Effects/Adverse Reactions? (Antibiotic)

Answer 21

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

Question 22

Tetracycline Drug-Food interactions?

Answer 22

Milk products

 Antacids

Question 23

Tetracycline Drug-Drug Interactions?

Answer 23

Oral contraceptives Can interfere with:
 Penicillin’s
 Aminoglycosides

Question 24

Tetracycline Assessment?

Answer 24

Assess vital signs and urine output

 Check lab results, especially renal and liver function.

Question 25

Vancomycin Drug Class?

Answer 25

Glycopeptide: strongest medication/antibiotic there is | For highly resistant bacteria

Question 26

Vancomycin Action?

Answer 26

Inhibits cell wall synthesis  Effective against gram positive MRSA  Bactericidal

Question 27

Vancomycin Use?

Answer 27

Respiratory, skin, and bone/joint infections  Bacteremia  Septicemia  Endocarditis  MRSA, C.diff associated diarrhea o VANCOMYCIN ALWAYS NEEDS PEAK AND TROUGH LEVELS DRAWN

Question 28

Vancomycin Side effects/ Adverse reactions? (Antibiotic)

Answer 28

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

Question 29

Ciprofloxacin (Cipro) Drug Class?

Answer 29

Fluoroquinolone

Question 30

Ciprofloxacin (Cipro) Action?

Answer 30

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

Question 31

Ciprofloxacin (Cipro) Use?

Answer 31

Anthrax – Cipro treats this |  skin, soft tissue, bone/joint, gynecologic, intraabdominal, urinary and respiratory tract infections

Question 32

Ciprofloxacin (Cipro) Side Effects/Adverse Reactions?

Answer 32

``` 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 ```

Question 33

Ciprofloxacin (Cipro) Assessment?

Answer 33

Record vital signs along with intake and output

Question 34

Ciprofloxacin (Cipro) Interventions?

Answer 34

``` 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 ```

Question 35

Metronidazole (Flagyl®) Drug Class?

Answer 35

Nitroimidazoles

Question 36

Metronidazole (Flagyl®) Action?

Answer 36

 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

Question 37

Metronidazole (Flagyl®) Use?

Answer 37

``` 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 ```

Question 38

Metronidazole (Flagyl®) Side Effects?Adverse reactions?

Answer 38

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)

Question 39

Nursing Process: Penicillins: planning?

Answer 39

The patient’s infection will be controlled and ultimately eliminated.

Question 40

Nursing Process: Penicillins: interventions?

Answer 40

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.

Question 41

Nursing Process: Cephalosporins: Assessment?

Answer 41

Assess for allergy to cephalosporins or penicillins. Record vital signs and urine output. ◦ Evaluate lab results, especially renal and liver function.

Question 42

Nursing Process: Cephalosporins: Planning?

Answer 42

The patient’s infection will be controlled and ultimately eliminated.

Question 43

Nursing Process: Cephalosporins: Interventions?

Answer 43

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.

Question 44

Nursing Process: Tetracyclines: Planning?

Answer 44

The patient’s infection will be controlled and | ultimately eliminated.

Question 45

Nursing Process: Tetracyclines: Interventions?

Answer 45

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.

Question 46

AMOXICILLIN/CLAVULANATE: Nursing Considerations

Answer 46

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