Exam 5 - Antimicrobial Agents Flashcards
When are antibiotics ok to use prophylactically?
-surgery
-Bacterial Endocarditis (like if they have a prosthetic heart valve or congenital heart disease)
-Neutropenia
-recurrent UTI
-exposure to STD
-prophylaxis against influenza and covid
what is selective toxicity?
ability to injure a microbe without injuring host cells
what is a superinfection?
an infection that appears when you are on antimicrobial therapy
what is an opportunistic infection?
your immune system is already weakened (like someone on chemo or on immunosuppressants) and an infection comes up
which of the following are associated with antibiotic resistance?
-spontaneous mutation
-use of antibiotics for viral infections
-broad spectrum antibiotics
-antibiotic use in agriculture
-pts not taking antibiotics as prescribed
-over prescription of antibiotics
for which antibiotic should you avoid alcohol with?
Metronidazole, because it causes a Disulfiram-like reaction
and
Cephalosporins
antiobiotic education for patients
-some require fridge
-if allergic wear ID
-avoid alcohol
-penicillins, take with full glass of water
-cephalosporins, take with food
three major ADRs to antibacterial medications
allergic reactions
superinfections
organ toxicities (especially the ear, liver, and kidneys)
what is true about the penicillins?
1) PCN is the most common cause of drug allergy
2)only rarely are patients allergic to penicillin
3) penicillins inhibit enzymes necessary for replication
4) penicillins weaken the bacterial cell wall, causing lysis and death
5) penicillin allergies are always mild and the pt can still receive penicillin
6)penicillin allergies symptoms range from mild to life threatening
1) PCN is the most common cause of drug allergy
4) penicillins weaken the bacterial cell wall, causing lysis and death
6)penicillin allergies symptoms range from mild to life threatening
penicillin and cephalosporins share the same MOA: they have a beta lactam ring. what else in common?
T/F: Both inhibit bacterial cell wall synthesis causing lysis and death
T/F: both are eliminated in the kidney and require decreased dose for those with impaired renal function
T/F: both can be administered with amino-glycosides to increase effectiveness
T, T, F
-both inhibit bacterial cell wall synthesis
-both are eliminated in the kidney
What can you administer penicillin with to increase effectiveness?
Amino-glycosides
* but be careful not to mix the IV solutions
T/F: pts with penicillin allergy may also have an allergy to the Cephalosporins
T (only 1%)
-for pts with mild penicillin allergy, cephalosporins can be used with minimal concern
-but if it is severe allergy, then be extra careful!
What does a disulfiram reaction look like in a patient?
nausea, vomiting, flushing, dizziness, throbbing headache, chest and abdominal discomfort, and general hangover-like symptoms
“pt has a new fever and lack energy, culture were sent and we have a gram positive growth in blood” we will start a Vancomycin
how will the dose be ordered?
1000mg IVPB q 12 hrs
-probably at least an 18 gauge
what are three side effects of Vancomycin?
-Nephrotoxicity !!! dose related, so to minimize risk, check peak and trough levels and renal creatinine
-Thrombophlebitis (blood clot causes inflammation and pain)
-Ototoxicity
-Rapid infusion risk:
Red Man syndrome (histamine release a/s w/ rapid IV infusion : aka flushing, rash, tachycardia, hypotension)
Tetracycline is avoided in children’s younger than 8, Why?
A) false, this drug is ok for children
B) medication causes most frequent drug allergy
C) medication binds to calcium
D) medication causes prolonged QT syndrom
medication binds to calcium
Tetracyclines
first broad spectrum antibiotic
current use is now more limited
MOA: inhibits protein synthesis, inhibit necessary binding in the RNA to messenger RNA
ADRS: monitor bowel function and asses for rash
What are the two most significant ADRs with amino-glycosides such as Gentamicin and Tobramycin
ototoxicity and nephrotoxicity
if a pt is receiving an IV drug that can cause nephrotoxicity, what nursing actions might be important?
renal labs, check urine
-hydrate pt before and after infusion
-do not administer NSAIDS
-can lower dose if impaired renal function
which antimicrobials are most associated with prolonged QT interval?
A) Levofloxacin
B) Penicillin
C) Erythromycin
D) Vancomycin
the Macrolides, Levofloxacin,
erythromycin (the olderst)
an elderly pt complains of confusion and new tenderness behind right ankle. Which recent prescription might be the cause?
A) Penicillin
B) Erythromycin
C) Ciprofloxacin
D) Vancomycin
ciprofloxacin – tendon rupture can be a problem
Fluoroquinolones ADRs
CNS, superinfection, photos—-??
What will we monitor for with Clindamycin?
may lead to C-Diff
-superinfection of bowel
Sulfonamides ADRs
-sulfa allergy and rash leading to Stevens Johnson syndrome, exfoliative dermatitis (skins sloughs off)
-Hemolytic Anemia (look at RBC) (and signs of anemia)
-Renal injury r/t to Crystalluria
Metronidazole is considered both an antibiotic and an
Antiprotozoal
(like for giardia )
Metronidazole considerations
-Slow IV infusion, monitor for phlebitis
-for PO take with food
-may have a metallic taste
which of these drugs is an antiviral?
A) Amphotericin B
B) acyclovir
C) Ketoconazole
D) Ganciclovir
end in vir
acyclovir
and Ganciclovir
What is the MOA for Acyclovir?
inhibits viral replication by suppressing synthesis of viral DNA
(prevents replication)
What will the nurse teach the patient about Acyclovir?
-watch out for nausea, vertigo, confusion, irritation with topical application
-don’t transfer the virus (no sex and use condoms)
-don’t transfer to other parts of your body
-clean and dry area before application of ointment
pt is immunocomprimised and now has VZV infection. the pt is receiving IV acyclovir. the nurse understands that there is a an organ toxicity– what is it?
nephrotoxicity– check BUN, urine out
which drug has a black box warning of
Granulocytopenia and thromboxytopenia?
acyclovir or ganciclovir ?
what labs to check?
ganciclovir, CBC with differential
(look for early signs of infection like soar throat)
vaccines are available for which?
Hep A
Hep B
Hep C
hep A and hep B
T/F: Hep C is usually treated with multiple drugs at the same time
true
triple therapy: Pegylated interferon alfa, Ribavirin,
What is an ADR for Interferon Alfa?
Is it PO or SubQ?
SubQ and Im
ADR is depression, flu like symptoms
T/F: Systemic Mycoses can be treated with over the counter medications?
what type of infection is this?
fungal infection
false – it is now fully in your system and hard to get rid of
What is Amphotericin B?
broad spectrum antifungal
very effective but potentially toxic
ADRs:
-infusion reaction
-nephrotoxicity, which may lead to hyperkalemia
what is the infusion reaction in amphotericin?
fever, rigors, hypotension, respiratory failure
– give Diphenhydramine and acetaminophen before giving the medication IV
– Rigors (shaking/ jerking) can be treated with Dantrolene or Meperedine
How to minimize ADRs for Amphotericin B?
-check renal function with labs and other electrolytes
-avoid other nephrotoxic drugs like amino-glycosides and cyclosporine, and NSAIDS
-monitor serum creatinine
-administer with normal saline
In prevention of HIV, what is the difference between PEP and PrEP?
PEP is treatment for a person possibly exposed at work
Post Exposure Prophylaxis
ex) needle stick
PrEP is Pre-Exposure Prophylaxis
ex) those at high risk for HIV, like HIV + sexual partner
the partner has high risk behaviours
UTI drugs
Trimethoprin/sulfamethoxazole
Nitrofurantoin
Fosfomycin
Phenazopyridine — not an antibiotic, its a urinary analgesic
Will turn patients urine orange
