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Pharmacology > Infection > Flashcards

Infection Flashcards

1
Q

What is a superinfection

A

A type of resistance that results when an antibiotic kills normal flora, thus favoring the emergence of a new infection that is difficult to eliminate

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2
Q

What lab tests should be completed before giving antibiotics?

A

Testing of body fluids: blood, urine, sputum, and wound drainage
Gram Stain: examine an aspirate of body fluids under a microscope to identify micro-organisms directly
Culture: aspirate is applied to a culture medium where colonies can grow

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3
Q

What is Clostridium difficle (C. diff)?

A

Disruption of normal healthy bacteria in the colon, usually from antibiotics, that results in watery and bloody stool

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4
Q

What are the beta-lactam antibiotics?

A

Cephalosporins, Macrolides, aminoglycosides, penicillins

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5
Q

Expected Pharmacological Action

Penicillin - Amoxicillin

A

Penicillin weaken and destroy the cell wall of bacteria that are sensitive. They do this by inhibiting the enzyme necessary for cell-wall formation, which is transpeptidase. Then, they activate the enzyme that opens the cell wall during replication, which is autolysin. Both of these actions weaken the cell wall and expedite the destruction of the bacteria

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6
Q

Adverse effects

Penicillin - Amoxicillin

A

GI symptoms: diarrhea, nauseas, vomiting; Rarely may cause C. Diff-superinfections (more frequent with other antibiotics than amoxicillin; superinfection with Candida albicans; Allergy to penicillin (rash, hives, wheezing and difficulty breathing)

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7
Q

Nursing Interventions

Penicillin - Amoxicillin

A

Monitor for GI symptoms; Monitor and report bloody stools or long-term watery diarrhea; monitor for and report candida infections of the mouth and vagina; expect to treat candida with an antifungal infection; ask clients if they are allergic prior to administering the first dose; monitor for allergy manifestations and notify provider; for injectable penicillin (IM or IV), keep client in facility for 30 minutes after administration and monitor for allergy; prepare to treat rash/hives with antihistamines, anaphylaxis with epinephrine and respiratory support

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8
Q

Interactions

Penicillin - Amoxicillin

A

Probenecid increases penicillin blood levels
Bacteriostatic agents may decrease therapeutic effects
Reduced effectiveness of oral contraceptives

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9
Q

What are the differences in treatments for generations of cephalosporins

A

Cephalexin is a first-generation cephalosporin that treats infections caused by gram-positive cocci
Subsequent generations of cephalosporins (drugs from the second, to fifth generation) are more active against gram-negative bacteria; more resistant to beta-lactamase (gram-positive) bacteria; more able to penetrate cerebrospinal fluid to treat infections, such as meningitis

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10
Q

Adverse Effects

Cephalosporins

A

GI symptoms: diarrhea, nausea; CDAD, which is rare, may be from superinfection; possible cross-allergy to penicillin allergy (especially for clients with a history of severe penicillin allergy); thrombophlebitis with cephalosporins infused IV; Cefotetan (Cefotan): disulfiram-like reaction if client takes with alcohol, risk for hemorrhage

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11
Q

Therapeutic Uses

Monobactam - aztreonam

A

Narrow-spectrum antibiotic that treats infections caused by gram-negative aerobic bacteria; lower respiratory infections; urinary tract infections; abdominal and gynecological infections

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12
Q

Contraindications/Precautions

Carbapenem - imipenem

A

Allergy to carbapenems; allergy to penicillin; allergy to cephalosporins; seizures; renal impairment

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13
Q

Therapeutic Uses

Vancomycin

A

Severe infections: Methicillin-resistant staphylococcus aureus infections (MRSA); Infections in clients with an allergy to penicillin; Clostridium Difficile associated diarrhea (CDAD)

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14
Q

Adverse Effects

Vancomycin

A

Renal failure secondary to nephrotoxicity; hypotension, tachycardia, and flushing of the face and trunk (“red man” syndrome) occur with rapid IV infusion; rare-ototoxicity (usually reversible); thrombophlebitis at IV site and tissue damage with IV infiltration

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15
Q

Client Education

Tetracycline

A

Take with non-dairy food if GI symptoms occur; report to provider if pregnant; giving the drug to children under the age of 8 should be avoided; report jaundice, abdominal pain, or fatigue to provider; report mouth pain and difficulty chewing or swallowing; report vaginal irritation/discharge; report watery or bloody stools; wear protective clothing and wear sunscreen for exposure

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16
Q

Contraindications

Tetracyclines

A

Pregnancy risk-teratogenic, children younger than 8 years old; allergy to tetracycline; exposure to ultraviolet light; serious renal or liver failure

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17
Q

Interactions

Tetracyclines

A

Absorption decreased by antidiarrheals containing kaolin, supplement and antacids containing calcium, magnesium, and aluminum
Dairy products and supplements with iron or zinc decrease absorption
Tetracyclines decrease effectiveness of oral contraceptives

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18
Q

Therapeutic Uses

Macrolides - erythromycin, azithromycin

A

First line treatment for: Legionnaires’ disease, Whooping cough, acute diphtheria, treatment of clients who are carriers of diphtheria, some Chlamydia infections, certain pneumonias
Treats common infections for clients who have a penicillin allergy
Ophthalmic ointment prevents eye infections in neonates

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19
Q

Adverse Effects

Macrolides - erythromycin, azithromycin

A

GI symptoms: nausea, vomiting, abdominal pain, and diarrhea; cardiac symptoms: serious ventricular dysrhythmias can result in death; ototoxicity: hearing loss, vertigo, and tinnitus (able to reverse when treatment ends); Superinfection (CDAD, candidiasis)

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20
Q

Client Education

Macrolides - erythromycin, azithromycin

A

Take with food if GI symptoms occur; report continuing of symptoms to provider; report palpitations and fainting spells to the provider; report hearing loss, vertigo, and tinnitus to provider; report watery or bloody diarrhea; report mouth pain with white patches on the oral mucosa, or vaginal discomfort and discharge

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21
Q

Adverse Effects

Aminoglycosides - gentamicin

A

Elevated trough levels of the drug (early signs include tinnitus, headache, and vertigo) can cause ototoxicity
Nephrotoxicity (polyuria, dilute urine, protein and casts in urine, elevated BUN, creatinine)
Ataxia

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22
Q

Nursing Interventions

Aminoglycosides - gentamicin

A

Monitor for and report tinnitus and other symptoms of early signs of toxicity; monitor for peak and trough levels; monitor laboratory values (BUN, creatinine, urine for protein and casts) and report elevations; evaluate of eight cranial nerve with audiometry; monitor I&O

23
Q

Client Education

Aminoglycosides - gentamicin

A

Report onset of tinnitus, headache, vertigo, or hearing loss to provider
Report an increase in the output of dilute urine to provider

24
Q

What is the suffix for fluoroquinolones?

A

-floxacin

25
Q

Interactions

Fluoroquinolones - ciprofalxin

A

Antacids, iron preparation, calcium (including dairy products), and sucralfate (Carafate) decrease oral absorption; Increase theophylline levels and the risk for CNS symptoms; Increase warfarin (Coumadin) levels; concurrent use of erythromycin, quinidine, some antipsychotics, and tricyclic antidepressants can increase the risk for torsade de pointes in those susceptible; Increase hypoglycemia occur when taken concurrently with antidiabetic medication

26
Q

Therapeutic Use

Sulfonamide - trimethoprim and sulfamethoxazole

A

Trimethoprim and sulfamethoxazole work together to treat: urinary tract infections, pneumocystis pneumonia, shigella enteritis (shigellosis, also called traveler’s diarrhea), chronic bronchitis (acute phase), acute otitis media in children

27
Q

Medication Administration

Sulfonamide - trimethoprim and sulfamethoxazole

A

Available as fixed-dose combination in tablets, liquid solution, and IV form; give oral dose with 8 oz. of water; administer intermittent IV infusion slowly (over 60-90 minutes) and with recommended dilution; drink at least 1200 to 1500 mL water/day during treatment with this drug

28
Q

Interactions

Sulfonamide - trimethoprim and sulfamethoxazole

A

Alcohol use with this drug may cause a disulfiram-type reaction; may increase effects of warfarin, phenytoin, tolbutamide (and other sulfonylurea oral antidiabetic drugs); taken with methotrexate, clients may have increased immunosuppression; reduced effectiveness of oral contraceptives (use alternative contraception)

29
Q

Adverse Effects

Urinary Tract Antiseptics - nitrofurantoin

A

GI symptoms: nausea, vomiting, and diarrhea; Respiratory symptoms: acute chills/fever, cough, lasts 2 to 4 days, subacute cough, shortness of breath, lasts weeks to months and may be permanent; permanent peripheral neuropathy (commonly in clients with impaired renal function); blood cell dysfunction (anemia, including hemolytic anemia, thrombocytopenia, neutropenia); tooth staining caused by contact with liquid suspension; urine may appear brownish (harmless side effect); dizziness, drowsiness, headache, and photosensitivity; pulmonary distress

30
Q

Client Education

Urinary Tract Antiseptics - nitrofurantoin

A

Take with food or milk; report acute or subacute respiratory symptoms, such as dyspnea, fever, or cough to the provider; report numbness, tingling, and weakness of extremities; report fatigue, easy bruising, or repeated infections to provider; swallow capsules whole; dilute liquid suspension; rinse mouth after taking suspension

31
Q

Therapeutic Use

Isoniazid

A

Treatment of active TB

Treatment of latent TB (positive TB skin test; disease not yet active)

32
Q

Adverse Effects

Isoniazid

A

Liver damage, including hepatitis, liver failure (especially common in older adults and clients with alcohol use disorder); peripheral neuropathy: numbness, tingling, pain in the hands or feet (especially common in clients who have diabetes or alcohol use disorder); CNS symptoms: dizziness, ataxia, seizures, psychotic symptoms; GI symptoms: nausea, vomiting

33
Q

Nursing Interventions

Isoniazid

A

Monitor for and report GI symptoms; work with client to encourage compliance with drug regimen; monitor levels of liver enzymes throughout therapy; monitor for and report signs of liver damage; administer pyridoxine (vitamin B6) as prescribed for neuropathy; monitor for and report CNS symptoms; monitor for signs of DRESS

34
Q

What are the signs of DRESS

A

Fever, rash, lymphadenopathy, and/or facial swelling, associated with involvement of other organ systems (hepatitis, nephritis, hematologic abnormalities, myocarditis, myositis)

35
Q

Contraindications

Isoniazid

A

History of allergy to isoniazid; history of liver damage from isoniazid; severe liver damage from any cause; chronic liver disease, including hepatitis, adults older than 50; seizure disorder; renal disorders; alcohol use disorder

36
Q

Evaluation of Medication Effectiveness

Isoniazid

A

Improvement of tuberculosis manifestations (clear breath sounds, no night sweats, increased appetites, and no afternoon rises of temperature)
Three negative sputum cultures for tuberculosis, usually taking 3 to 6 months to achieve

37
Q

Therapeutic Use

Rifamycin - rifampin

A

Adjunct therapy to treat TB; effective against Neisseria meningitidis (cause of meningococcal meningitis), legionella (responsible for Legionnaires disease), and staphylococcus aureus; may treat leprosy; prevents hemophilus influenza infection

38
Q

Adverse Effects

Rifamycin - rifampin

A

Liver toxicity (hepatitis); red-orange color of body fluids (urine, saliva, tears, sweat); GI symptoms (nausea, vomiting, diarrhea, cramping, abdominal pain); flushing, rash, itching

39
Q

Nursing Interventions

Rifamycin - rifampin

A

Monitor liver enzyme levels throughout therapy; monitor for and report symptoms of hepatitis; observe for presence of soft contact lenses-may become stained by tears; monitor for and report persistent GI symptoms; monitor for signs of DRESS, therapy should be stopped if symptoms appear

40
Q

Interactions

Rifamycin - rifampin

A

Decreases blood levels of oral contraceptives, warfarin (Coumadin) and several HIV drugs (protease inhibitors)
Isoniazid and pyrazinamide increase risk for liver toxicity

41
Q

Therapeutic Use

Anti-infective, antiprotozoal, antiulcer - metronidazole

A

IV form treats anaerobic bacterial infections, such a colorectal. abdominal, and vaginal surgeries; oral form treats some bacterial infections which include: CDAD, bacterial vaginal infections; Oral also treats protozoal infections which include: intestinal and systemic amebiases, giardiasis, trichomoniasis in both males and females

42
Q

Client Education

Anti-infective, antiprotozoal, antiulcer - metronidazole

A

Take just before, with, or after a meal if GI symptoms occur; report severe GI symptoms to provider; report CNS symptoms to provider; do not be alarmed if darkening of urine occurs during treatment; instruct clients that they may experience a metallic taste, headache, and dizziness; advise client to avoid alcohol

43
Q

Therapeutic Use

Antimalarial - chloroquine

A

Treats chloroquine-sensitive malaria. Combination with primaquine is necessary to cure malaria caused by two of the parasites; prophylaxis for malaria in regions where chloroquine resistance is not widespread; treats amebiasis; second-line therapy to treat rheumatoid arthritis and systemic lupus erythematosus

44
Q

Adverse Effects

Antimalarial - chloroquine

A 
Visual symptoms
GI symptoms (nausea, diarrhea)
45
Q

Medication Administration

Antifungal - amphotericin B

A

Available for IV infusion, treatment given daily; infuse IV form at recommended dilution and rate, monitor IV site carefully for thrombophlebitis; if ordered, administer a test dose to determine how the client tolerates the drug; there is a lipid-based from available for IV use with less adverse effects, but a much more expensive formulation; Oral suspension: the client may “swish and swallow” oral suspension for oral Candida (thrush) infections, instruct the client to swish well in mouth before swallowing

46
Q

Therapeutic Use

Antiviral - acyclovir

A

IV: treats severe viral infections in clients who are immunocompromised
Oral: treats symptoms of severe viral infections in clients with normal immune systems
Topical: treats symptoms of viral infections such as cold sores, initial genital herpes outbreaks, and mild skin infections for clients who are immunocompromised

47
Q

Adverse Effects

Antiviral - acyclovir

A

IV: Renal toxicity; CNS toxicity (rare, client with renal impairment are at the most risk), restlessness, tremors, psychosis, seizures; thrombophlebitis at IV site; IV infiltration causes tissue damage
Oral: GI symptoms (nausea, vomiting, diarrhea, headache); vertigo
Topical: burning, itching at application site (usually temporary)

48
Q

Adverse Effects

Azoles - ketoconazole

A

Systemic Use: Liver toxicity; GI symptoms (nausea/vomiting, constipation, or diarrhea); drowsiness, dizziness (decreases during duration of treatment)

49
Q

Nursing Interventions

Vaccines

A

Have emergency medications and equipment on standby in case the client experiences an allergic reaction; Instruct clients to observe for complications and notify provider

50
Q

What is the timeframe to give oseltamivir (Tamiflu)

A

Within 48 hours of flu symptom onset

51
Q

Therapeutic Use

Inhaled ribavirin

A

Anti-viral drug used to treat infants and young children who have a severe lung infection caused by RSV

52
Q

Which immune cells does HIV/AIDS destroy?

A

CD4+ T cells

53
Q

Adverse Effects

Cancer

A

Bone marrow suppression, nausea/vomiting, hair loss

54
Q

Client Education

Cancer

A

Follow strict hand hygiene; avoid crowds; avoid raw or uncooked food (including fruits and vegetables that are eaten raw); report nausea

Pharmacology (9 decks)

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