Infectious Diseases Pt. 1 Flashcards
What are the four adverse effects of ALL antibiotics?
- Allergic Reactions
- Super/Supra Infection
- Always Finish the Therapy
- Antibiotics can Interfere with lots of Drugs
Describe allergic reactions (adverse effects).
ASSESS - allergies of your patients
- If they list an allergy, investigate! What happened?
- Type I or Type 4
EVALUATE - after giving an antibiotic, observe your patient for a reaction (~30 minutes after end of infusion)
- Manage reaction!
Describe super/supra infection (adverse effects).
Antibiotics kill bad bacteria + protective bacteria
- RISK 1: Clostridium difficile infection (Pseudomembranous Colitis)
> Preventative- probiotics
> Treatment: antibiotics
- RISK 2: Candida albicans infection
> Oral/vaginal- treat with antifungals
Why should you always finish the entire therapy (adverse effects)?
- **Never stop early (even if feeling better )
- Premature stoppage can cause resistant bacteria
Describe how antibiotics can interact with a lot of drugs (adverse effects).
- ORAL CONTRACEPTIVES
~ Theoretical studies have shown that antibiotics may kill gut flora that helps absorb oral contraceptives (unintended pregnancy risk!) - WARFARIN
~ Antibiotics can kill part of the gut flora that helps absorb Vitamin K (Klotting!)
~ Warfarin blocks Vitamin K, Antibiotics reduce Vitamin K = increased bleeding risk (INR)
Describe type 1 hypersensitivity - allergic reaction.
Anaphylaxis: B-cell mediated
- LIFE-THREATENING
- IgE mediated
- Histamine gets released which causes capillary leakage (swelling of airways and difficulty breathing), itching, and more dangerously a drop in blood pressure
UH-OH ANGIE
Urticaria, Hives, Oxygen gone, Hypotension, Angioedema
What is an example of a type 1 hypersensitivity allergic reaction?
Penicillin
What are nursing actions to treat anaphylaxis?
1) Stop medication immediately (turn off the IV!) and notify Rapid Response Team
2) Establish an Airway to maintain ventilation (bronchodilators if needed)
3) Administer Oxygen
4) Treat with Epinephrine (IM or IV) every 5 to 10 minutes if needed
5) Administer diphenhydramine (decrease angioedema and urticaria)
How do you use an EpiPen?
- Do not place hands over any ends of the pen (risk for accidental poke)
- **“Blue to the Sky, Orange to the Thigh”
- Remove the safety cap**
- Okay to inject through clothes!
- “Hold for 3-10 seconds”
- Can massage the site afterward (10 seconds) Generally, the only time you massage
- You can use another dose 5-15 minutes after (max is 2 doses)
- SEEK MEDICAL HELP!
What are examples of type 4 hypersensitivity allergic reactions?
Severe Cutaneous Adverse Reactions (SCAR)
- Steven Johnson Syndrome (SJS)
- Toxic Epidermal Necrolysis (TEN)
- Allopurinol, Anti-epilepsy drugs
(T-cell mediated - delayed hypersensitivity)
What are the early warning signs of type 4 hypersensitivity?
- FEVER + Flu-like symptoms
- RASH -> Blistering
- Lip peeling, mouth sores
What is the mechanism of action of penicillin?
- Penicillin binds to and inactivates penicillin-binding proteins (PBPs/transpeptidases) produced by bacteria
- Penicillin Binding Proteins normally help in the synthesis of bacteria cell walls
- Inhibiting PBPs results in bacteria lysis/death
What is the pharmacology of penicillin?
Binding to penicillin-binding protein of bacterial cell wall and destroys the bacteria
Describe the allergic reaction to penicillin.
- (0.1-10% receiving PCN have a reaction)- HUGE!
- Assess and evaluate
- Interview clients for prior allergies.
- Observe for allergic reactions for 30 min following parenteral administration of penicillin.
Describe the pharmacokinetics of penicillin - adverse effects
- Almost all Beta Lactams are RENALLY eliminated
- Accumulation can cause seizures/CNS disturbances
- Change frequency based on toxicity
Describe super/supra infection of penicillin.
ALL ANTIBIOTICS are at increased risk for super/supra-infection
1) Pseudomembranous colitis aka C.diff infection
- Warning signs?
- Prevention/Management?
2) Candida albicans
- Oral, vaginal
- Signs/Symptoms?
- Prevention/Management?
When should you not give penicillin?
History of a BETA-LACTAM allergy (cross-reactivity)
- This means penicillins, cephalosporins, carbapenems, monobactams
Current infection with EBV (Mononucleosis)
- Common to see a rash if a patient has Mono (EBV)
- Specifically seen with amino-penicillins (like amoxicillin)
What is warfarin?
- Warfarin is an anticoagulant which reduces Vitamin K clotting factors
- Vitamin K= Vitamin KLOTTING (Clotting)
- Antibiotics can reduce vitamin K absorption in the gut
- Antibiotics= less vitamin K
- Warfarin usage = less vitamin K
- Result = very little Vitamin K in the body
List two oral contraceptives.
- Combination Oral Contraceptives (COCs) = Estrogen + Progestin
- Progestin Only Pills (POP/Mini Pills) = Progestin-only
- Need ALTERNATE contraceptive for all antibiotics: IUD, condoms, etc.
Describe penicillin G/V potassium.
- G is IV, V is oral
- can cause hyperkalemia
Describe penicillin G benzathine + penicillin G procaine.
- given via IM injection
- thick white paste appearance
- NEVER GIVE IV
What are some administration considerations for penicillin?
- educate the patient to ALWAYS finish the entire course of therapy-never stop antibiotics prematurely
- penicillin G benzathine and penicillin G procaine are IM only
What is penicillin used to treat?
- Strep
- Piperacillin- Pseudomonas, Klebsiella
What are some nursing considerations for penicillin?
Intended Outcomes
~ resolve the infection
Unintended Outcomes
~ review the monitoring points of each adverse effect
What are beta-lactamase inhibitors?
NOT AN ANTIBIOTIC
- adds coverage to other antibiotics
How are beta-lactamase inhibitors given?
NEVER given by itself
- ALWAYS combined with an antibiotic
Describe the mechanism of action of beta-lactamase inhibitors.
Bind to and inactivate the beta-lactamase inhibitor enzymes
List some beta-lactamase inhibitors.
- Tazobactam- IV
- Clavulanate/Clavulanic acid- PO
What are some adverse reactions of cephalosporins?
-
Allergic Reaction
~ very similar to penicillin’s (seizures, CNS confusion)
~ cross sensitivity- beta lactams -
Diarrhea
~ abdominal cramps (notify provider) -
Supra-infection
~ pseudomembranous colitis, candida albicans -
Phlebitis with IV Infusion
~ rotate injection sites - CEFTRIAXONE IM = MIX LIDOCAINE (numbing agent)
- Can accumulate in Renal Impairment just like PCNs
-
Unique to “Cefs”
~ Disulfiram-like reaction with EtOH - Bleeding Risk
What are the drug interactions with cephalosporins?
-
Probenecid
~ will prolong the drug’s half-life in the body - NO ALCOHOL
-
Gut Flora
~ Warfarin - reduced vitamin K in the gut
~ Oral contraceptives - theoretically decrease absorption
How is cephalosporin administered IM route?
- Administer IM injections deep into a large muscle mass (into the ventrogluteal site). Educate the client about the possibility of pain at the injection site before administration.
- Often lidocaine mixed with ceftriaxone to reduce the pain of IM injections
How is cephalosporin administered orally?
- Refrigerate Oral Suspensions (shake well!)
- TAKE these with FOOD!
What are carbapenems used to treat?
- severe infections, pseudomonas aeruginosa
Describe the mechanism of action of carbapenems.
same as penicillins and cephalosporins
What are the adverse effects of carbapenems?
- Same as PCNS, Cephalosporins
-
Allergic Reactions
> cross-sensitivity to beta-lactams - Seizure Risk! Big Carbapenem Class effect
- CNS – confusion, hallucinations
How do carbapenems react with other drugs?
Carbapenems lower levels of Divalproex/Valproate/Valproic Acid (seizure med)
~ Makes Valproate less effective
What are monobactams used to treat?
- Aerobic Gram-Negative Bacteria
- Pseudomonas aeruginosa
- Inhaled form for Cystic Fibrosis
- Meningitis, UTIs, sepsis
What are the adverse effects of monobactams?
- Relatively Safe
- Same as other beta-lactams- mostly GI
- Cross sensitivity to beta-lactams
Describe Assess of the Nursing Process.
- allergies
- renal function
Describe Diagnose of the Nursing Process.
- does the patient have an infection?
- as evidenced by?
Describe Planning of the Nursing Process.
- duration of abx therapy
- educate about adverse effects
- what makes them similar?
Describe Implementation of the Nursing Process.
- IV/IM administration
- special oral administration considerations
Describe Evaluation of the Nursing Process.
- intended outcome - how do we know the abx worked?
- unintended outcome - any common adverse effects? any strange adverse effects?
Define bactericidal.
kill bacteria
Define bacteriostatic.
inhibit growth of susceptible bacteria
How do you identify the infection?
Step 1: Obtain Culture
~ Get BLOOD cultures!
~ Followed by antibiotics
Step 2: Send Culture to the Lab
~ The lab will Gram Stain (tells you bacteria type)
~ The lab will test Sensitivity (which antibiotic will work)
Takeaway
all antibiotics today are called BETA-LACTAMS
- penicillins - “cillin”
- cephalosporins - “cef”, “ceph”
- carbapenems - “penem”
- monobactams - aztreonam
