Infection Flashcards
Effect of Antibiotics on Oral Contraceptive Use
Decreases effectiveness
Superinfection
infection as a result of decreased normal flora from antibiotic use
ex: C.diff & oral/vaginal yeast
Symptoms: fever, lethargy, mouth sores, perineal itching, diarrhea
Beta-lactam antibiotics
have a beta-lactam ring as part of their structure
Includes: penicillins, cephalosporins, carbapenems, monobactams
If a bacteria has Beta Lactamases
it is resistant to beta-lactam antibiotics, it is an acquired resistance
ex: ESBL(extended spectrum beta-lactamases)
When administering antibiotics consider
- give with correct food/fluids
- do not give antibiotics with antiacids, iron products, calcium supplements, laxatives containing magnesium, antilipemic drugs
What is a normal Creatine Level
1; very specific for renal damage
What should BUN be at
10-20; indicates renal failure, but can be high for other reasons
Sulfonamides (common names)
usually combines with other antibiotics
- sulfamethoxazole
- trimethoprim (Bactrim)
Sulfanomides (organisms affected)
Bacteriostatic med
gram - & gram +
Sulfonamides (indication)
UTI, outpatient, staph, respiratory tract infection, prophylaxis for HIV
Sulfonamides (contraindication)
- do not use with known allergies
- Celebrex should not be taken by patients with sulfa allergy
- not for pregnant women at term or infant <2 months
Sulfonamides (nursing considerations)
- increase fluid intake (med concentrates in kidneys which is good for UTI but can cause crystalluria)
- don’t give with sulfonylureas, phenytoin, warfarin
- assess skin, renal and liver function during administration
Sulfonamides (adverse effects)
- Hypersensitivity (Stevens-Johnson syndrome)
- delayed allergic reaction (may react weeks after)
- photosensitivity (avoid prolonged sun exposure)
- liver and renal toxicity
Penicillin (common names)
amoxicillin, ampicillin, nafcillin, Penicillin G, Penicillin V
in some combinations (piperacillin/tazobactam (zosyn)
Penicillin (microorganisms affected)
bacteriocidal
gram +
limited gram -; except extended run penicillins (zosyn)
Penicillin (indications)
infectious from
streptococcus
enterococcus
staphylococcus
Penicillin (contraindication)
do not use with known drug allergies
cross-reaction with cephalosporins
Penicillin (nursing considerations)
- increases the effectiveness of warfarin and methotrexate
- Penicillin G contains potassium
- take with 6oz of water (not juice)
- give in large muscle if IM
Penicillin (adverse effects)
uticaria, pruitis, angiodema
stevens-johnson syndrome
nausea/vomiting, diarrhea, anemia, hyperkalemia, hypernatremia, hypernatremia, alkalosis
Cephalosporins (common names)
1st: cephalexin (keflex), cefazolin (ancef)
2nd: cefprozil
3rd: cefdinir, ceftriaxone (rocephin), cefotaxime, ceftazidime (fortaz) (potent gram -)
4th: cefepime
5th: ceftaroline
Cephalosporins (microorganism affected)
bacteriocidal
Broad spectrum
1st: gram +
2nd: gram + & gram -
3rd: gram -
4th: gram + & gram -
5th: gram + & gram -
as generation increases, gram + coverage decreases, and gram - increases
Cephalosporins (indications)
gram + and gram - infections
ceftriaxone (Rocephin) 93% protein-bound, one dose could kill some infections
treats meningitis (crosses the BBB)
Cephalosporins (nursing considerations)
do not use with known allergy
avoid alcohol
antibacterial activity increases from 1st to 4th
Cephalosporins (adverse reactions)
allergic: diarrhea/nausea/vomiting
neutropenia (low WBCs)
bleeding
each class has own side effects
Carbapenems (common names)
imipenem/cisplatin, etrapenem
doripenem, meropenem
all end in -enem
Carbapenems (microorganisms affected)
bactericidal
broadest antibacterial action of any antibiotic
Carbapenems (indications)
body cavity infections/connective tissue infections/bone infections in acutely ill hospitalized patients
meropenem cross the BBB used for meningitis
Carbapenems (nursing considerations)
infuse over 60 minutes
small cross-reaction with penicillin- do not give to patients with anaphylactic reactions to PCN
Carbapenems (adverse effects)
drug induced seizure
GI upset
thrombocytopenia (low platelet count)
Macrolides (common name)
azithromycin
clarithromycin
erythromycin
Macrolides (microorganism affected)
bacteriostatic
in large doses bacteriocidal
broad spectrum
Macrolides (indications)
strep, syphilis, Lyme disease, gonorrhea, chlamydia, some new macrolides treat C.diff
Macrolides (Nursing Considerations)
do not use if allergic
highly protein-bound and metabolized through the liver
do not give with carbamazepine, cyclosporine, theophylline, warfarin
Do not give with juice
Macrolides (Adverse Effects)
- GI symptoms, chest pain
- EKG changes (prolonged Q-T segment)
- allergic reaction
- tinnitus, abnormal liver function
Prolonged QT interval (segment) could cause
increased risk for dysrhythmias that could be lethal
Tetracyclines (common names)
doxycycline, tetracycline
end in -cycline
Tetracyclines (microorganisms affected)
bacteriostatic
gram + & gram -
Tetracyclines (indications)
syphilis, Lyme disease, PID, mycoplasma
chlamydia (drug of choise)
rickettsia
Tetracyclines (nursing considerations)
do not take with milk or dairy
do not take Ca, Fe, Or, Mg, or antacids
use sun protection
Take with 8oz of water
avoid use during pregnancy
Tetracyclines (adverse effects)
photosensitivity
discolored teeth in fetus/child
decreased growth in skeletal bones of fetus
GI upset (investigate diarrhea could be C.diff)
Aminoglycosides (common names)
amikacin, gentamicin, tobramycin, neomycin
Aminoglycosides (microorganisms affected)
gram - and some gram +
Aminoglycosides (indications)
- gram - pseudomonas, enterobacter, proteus, kebsiella
- gram + strep, staph, (bacterial endocarditis),
- neomycin given for bacterial decontamination prior to GI surgery can reduce the ammonia-producing bacteria in the gut for patients with cirrhosis
Aminoglycosides (contraindications)
pregnancy category C or D (permanent hearing loss in infant)
drug allergy do not give
Aminoglycosides (nursing considerations)
monitor serum drug levels
may be given once a day
through levels above 2 mcg/ml is a risk for toxicity
Aminoglycosides (adverse effects)
ototoxic
nephrotoxic (renal casts - visible remnants of destroyed renal cells, proteinuria and increased BUN
Quinolones (common names)
ciprofloxacin, levofloxacin
end in -floaxcin
Quinolones (microorganism affected)
bacteriocidal
broad spectrum
Quinolones (indications)
excreted by kidneys as unchanged drug
used for UTI
respiratory, skin GI, bone, and joint infection
Cipro used for exposure to anthrax
Quinolones (nursing considerations)
do not administer with antacids or MVI with iron
infuse over 1 - 1.5 hours
monitor for ECG changes
dairy reduces absorption
Quinolones (adverse effects)
prolong QT interval
black box warning for: tendon rupture, tendonitis, abnormal cartilage development, seizures, peripheral neuropathy, liver damage
Clindamycin (common names)
Cleocin
Clindamycin (microorganism affected)
gram + anaerobes
bactericidal or bacteriostatic
Clindamycin (indications)
chronic bone infections, abdominal infections, GU, staph, and strep
Clindamycin (nursing considerations)
DO NOT use with ulcerative colitis or enteritis and infants
do not give with NMB drugs
Clindamycin (adverse effects)
GI effects: nausea, vomiting
assess for c.diff
high risk of development of pseudomembranous colitis
Metronidazole (common name)
flagyl
antibiotic and antiprotozoal
Metronidazole (microorganism affected)
anaerobes
Metronidazole (indications)
intraabdominal and gynecological infections
clostridium, Bacteroides,
protozoal infections (amebiasis and trichomoniasis)
Metronidazole (nursing considerations)
- no alcohol for 24 hours before and up to 36 hours after last dose
- multiple drug interactions, changes the urine dark or red/brown
Metronidazole (adverse effects)
dizziness, HA, GI discomfort, neutropenia, thrombocytopenia
Vancomycin (microorganism affected)
gram +
Vancomycin (indications)
drug of choice for MRSA
can be used for c.diff
not used for gram -
Vancomycin (nursing considerations)
administer over at least 1 hr
draw drug levels (trough 10-20)
monitor serum creatine
additive NMB effect
Vancomycin (adverse effects)
ototoxic, nephrotoxic
red man syndrome (flushed feeling, facial itch, decreased BP) if happens slow rate of infusion
Linezolid (microorganism affected)
developed to treat VRE
treats MDRO
Linezolid (indications)
VRE, healthcare-associated pneumonia, MDROs
Linezolid (nursing considerations)
stop SSRIs while taking
avoid tyramine containing food (cheese, wine, soy sauce, smoked meats- raise BP)
potentiates vasopressors
Linezolid (adverse effects)
HA, n/v/d
myelosuppression (anemia, leukopenia, thrombocytopenia)
Acyclovir (virus treated)
HSV-1, HSV-2, VZV
Acyclovir (indications)
valaciclovir metabolized to acyclovir and has greater bioavailability (less frequent dosing)
Acyclovir (nursing considerations)
infused over 1 hour
maintain adequate hydration,
use gloves when applying topically
Acyclovir (adverse effects)
n/v/d
burning when topically applied
Ganciclovir (virus treated)
CMV
organ transplant: to prevent CMV
Ganciclovir (nursing considerations)
obtain CBC prior to giving
causes bone marrow suppression
use caution when handling
Oseltamivir & Zanamivir (common names)
oseltamivir = tamiflu
zanamivir = relenza
Oseltamivir & Zanamivir (virus treated)
influenza A & B
Oseltamivir/Zanamivir (nursing considerations)
give with 2 days of onset of flu sx
Osltamivin & Zanamivir (adverse effects)
oseltamivir: n/v
Zanamivir: diarrhea, nausea, sinusitis
Ribavirin (virus treated)
RSV (inhaled)
Ribavirin (nursing considerations)
- black box warning
- pregnancy category X for teratogenic effects (no pregnant patient or male partners for 6 mo. after exposure)
- use 2 reliable methods of birth control
- pregnant caregivers stay out of room when aerosolized med is used
Ribavirin (adverse effects)
birth defects
Ethambutol (common side effects)
blindness
Streptomycin (common side effects)
ototoxic, nephrotoxic (not used for pregnant patients)
Isoniazid (common side effetcs)
peripheral neuropathy, hepatotoxicity, visual disturbance, hyperglycemia
Rifampin (common side effects)
turns urine, tears, sweat, and septum red/brown, can cause hepatitis
Amphotericin B (indication)
severe systemic mycoses
Amphotericin B (contraindications)
renal impairment, bone marrow suppression
Amphotericin B (nursing considerations)
Pretreat with antipyretics,
antihistamines, antiemetics,
and corticosteroids, continuous
monitoring through infusion.
Monitor vs q 15 minutes
Amphotericin B (Adverse effects)
Almost all pt have fevers,
chills, hypotension,
tachycardia, malaise,
muscle & joint pain,
anorexia, n/v, HA.
Hypokalemia, numbness,
tingling, tinnitus, liver
toxicity, nephrotoxicity,
cardiac dysrhythmias
Fluconazole (common name)
diflucan
Fluconazole (contraindications)
Vaginal candidiasis, oral, esophageal, UT systemic fungal infections
Fluconazole (nursing considerations)
Excellent bioavailability- one dose treats most vaginal candidiasis infections
Fluconazole (adverse effects)
n/v/d
Nystatin (common name)
Mycostatin
Nystatin (indication)
Oral candidiasis, candida diaper rash, prophylaxis for neutropenic patients
Nystatin (contraindications)
drug allergy
Nystatin (nursing indications)
oral or topical only
Nystatin (adverse effects)
n/v/d
Chloroquine & hydroxy-chloroquine
(common names)
Plaquenil
Chloroquine & hydroxy-chloroquine (indication)
Malaria (drug of choice), amebiasis, anti-inflammatory
Rheumatoid arthritis, SLE
Chloroquine & hydroxy-chloroquine (contratindication)
visual changes, optic neuritis, psoriasis
Chloroquine & hydroxy-chloroquine (nursing consideration)
may be given prophylactically when traveling to places with high rates of malaria.
May have loading doses
Chloroquine & hydroxy-chloroquine (adverse effects)
diarrhea, n/v, dizziness, HA, SZ rash, pruritis
Ivermectin (indications)
intestinal infection with threadworms
Ivermectin (nursing consideration)
stool specimen, assess food eaten
