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320 Pharmacology > Infectious Diseases Pt. 2 > Flashcards

Infectious Diseases Pt. 2 Flashcards

1
Q

List an example of a glycopeptide.

A

vancomycin

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2
Q

What is vancomycin used to treat?

A
  • Gram + only
  • MRSA (IV only)
  • Clostridium difficile (C.diff) (PO only)
  • pneumonia, meningitis, osteomyelitis, UTIs, sepsis, etc.
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3
Q

What are the big three adverse effects of vancomycin?

A
  1. Nephrotoxicity
  2. Ototoxicity
  3. Histamine release / flushing syndrome
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4
Q

What should you monitor if patient has nephrotoxicity?

A

SCr/BUN, vancomycin levels (troughs)

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5
Q

Describe ototoxicity.

A
  • Rare and potentially reversible
  • Vestibular damage- dizziness/balance
  • Cochlea- hearing, tinnitus (ringing in ears), fullness in ears
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6
Q

Describe Vancomycin Infusion Reaction / histamine release / flushing syndrome.

A
  • Formerly (and still called) “Red Man Syndrome”
  • (via mast cell degranulation)
  • Rash, Itching, Flushing
  • Tachycardia, Hypotension
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7
Q

Which drugs does vancomycin have drug interactions with?

A
  • Big concern- other nephrotoxic drugs
  • Also- other ototoxic drugs
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8
Q

What should you be monitoring if a patient is on vancomycin?

A
  • SCr/BUN
  • Vancomycin trough levels: 10-20mcg/mL
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9
Q

Describe nursing considerations for Vancomycin Infusion Reaction/ Red Man Syndrome/ Histamine Flush.

A
  • Make sure it is sufficiently diluted (1 gm/hr)
  • Usually caused by too RAPID of infusion- SLOW IT DOWN (at least over 60 minutes)
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10
Q

Describe nursing considerations for ototoxicity.

A

Assess for hearing loss, monitor drug levels, encourage patients to report hearing or vestibular changes

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11
Q

Describe nursing considerations for nephrotoxicity.

A
  • Assess kidney function- HOW?
  • Check trough levels, range- appropriately drawn?
  • REVIEW- PEAK and TROUGH DRAWING TIMES
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12
Q

How should you administer vancomycin?

A
  • ALWAYS FINISH THE ENTIRE COURSE OF THERAPY (EVEN IF SYMPTOMS IMPROVE EARLY!)
  • Dilute the IV infusion, rotate sites for IM, SLOW INFUSION (at least 1 hour)
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13
Q

List the types of macrolides.

A

[ACE] Azithromycin, Clarithromycin , Erythromycin, (Clindamycin)

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14
Q

What are macrolides used to treat?

A
  • Broad Gram +/- coverage
  • Useful for Penicillin Allergies
  • Erythromycin- Prokinetic- Gastroparesis
  • Legionnaire’s disease
  • Great for URTI, LRTI, Chlamydia, pelvic inflammatory disease, lots more
  • STD/STI
  • Mycoplasma pneumoniae (CAP)
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15
Q

What is the mechanism of action of macrolides (Azithromycin, Erythromycin)?

A
  • Inhibit protein synthesis by binding to the 50s ribosomal subunit
  • Appear to have anti-inflammatory properties
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16
Q

What are some adverse effects of macrolides (Azithromycin, Erythromycin)?

A
  • HEART PROBLEMS!
    ~ QT prolongation!, heart palpitations, dysrhythmias
    ~ Studies have shown they block K+ channels at high doses
  • OTOTOXICITY (high dose therapy)
    ~ Think Erythromycin, Think Ears
  • GI: N/V/D
    ~ Take with food!
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17
Q

Describe some drug-drug interactions of macrolides (Azithromycin, Erythromycin).

A
  • Any QT prolonging drugs
  • CYP3A4 drugs- macrolides function as inhibitors
    ~ Just like grapefruit juice!
  • Oral Contraceptives- decreased effectiveness
  • Other drugs like azoles, CCBs can increase macrolides, putting patient at higher risk for HEART PROBLEMS
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18
Q

How should you administer macrolides?

A

ALWAYS FINISH THE ENTIRE COURSE OF THERAPY (EVEN IF SYMPTOMS IMPROVE EARLY!)

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19
Q

List examples of tetracyclines.

A

Doxycycline, Minocycline, Demeclocycline

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20
Q

What are tetracyclines used to treat?

A
  • Acne- topical and oral preparations
  • Lyme Disease
  • Mycoplasma pneumoniae (CAP)
  • H. pylori (peptic ulcer disease)
  • Rocky Mountain Spotted Fever (Rickettsia diseases)
  • Chlamydia
  • Anthrax
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21
Q

What is the mechanism of action of tetracyclines?

A

Bind to the 30s ribosomal subunit, inhibits binding of transfer RNA to messenger RNA-ribosome complex

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22
Q

What are some adverse effects of tetracyclines?

A
  • GI problems
  • Hepatotoxicity in large doses
  • Photosensitivity
  • Tooth discoloration
  • Can suppress bone growth in infants
  • Risk for super infection / overgrowth
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23
Q

Describe adverse effects of tetracyclines. [GI]

A
  • GI PROBLEMS
    ~ very irritating to the G.I. tract- can cause ulceration
    ~ take with full glass of water, avoid bedtime
  • Hepatotoxicity with larges doses
  • PHOTOSENSITIVITY- sunburn very easily
    ~ Wear protective clothing, SPF
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24
Q

Describe adverse effects of tetracyclines. [Calcium]

A
  • BINDS TO CALCIUM- TOOTH DISCOLORATION
    ~ Avoid Calcium products
    ~ DO NOT GIVE TO CHILDREN, PREGNANT PATIENTS
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25
Q

Describe adverse effects of tetracyclines. [Growth]

A
  • Can suppress bone growth in developing infants, reversible once stopped (avoid in children less than 8)
  • Risk for Super Infection/Overgrowth
    ~ Antibiotic pseudomembranous colitis
    ~ C.diff associated diarrhea (CDAD)
    ~ Candida albicans- oral/vaginal candidiasis
26
Q

What are some drug-drug interactions of tetracyclines?

A
  • calcium, iron, magnesium, aluminum products
    ~ separate administration times
    ~ Take on empty stomach (full glass of water)
  • Oral Contraceptives and Warfarin
27
Q

Describe administration of tetracyclines.

A
  • ALWAYS FINISH THE ENTIRE COURSE OF THERAPY (EVEN IF SYMPTOMS IMPROVE EARLY!)
  • Take with FULL GLASS OF WATER, AVOID BEDTIME, AVOID CALCIUM!
28
Q

Describe contra-indications / avoid in of tetracyclines.

A
  • Pregnant Women
  • Nursing Women
  • Children < 8 years old
29
Q

List types of Aminoglycosides.

A

Gentamicin, Tobramycin, Neomycin, Amikacin

30
Q

What do Aminoglycosides treat?

A
  • Gram-negative only as a monotherapy
  • Gram-positive synergy with Abx that weakens bacterial cell wall (amoxicillin + gentamicin)
  • Have a post-antibiotic effect
  • Neomycin- topical for eyes, ears, skin
31
Q

What are the mechanisms of Aminoglycosides?

A

Disrupts protein synthesis by binding to 30s ribosomal subunit, believe to inhibit protein synthesis and promote production of abnormal proteins (post-antibiotic effect)

32
Q

What are the adverse effects of Aminoglycosides?

A
  • Nephrotoxicity! cumulative doses and troughs
    ~ Monitor? SCr/BUN, CrCl/GFR, I&O
  • Ototoxicity! due to elevated troughs
    ~ Tinnitus, hearing loss, balance
  • Requires frequent monitoring- peaks and troughs
33
Q

What should you not mix with Aminoglycosides?

A

Penicillin (in same syringe or IV site)

34
Q

What time to draw to check for adverse effects of Aminoglycosides (PEAKS)?

A

1/2 hour after infusion time is over

35
Q

What time to draw to check for adverse effects of Aminoglycosides (TROUGHS)?

A

1/2 hour before the drug is due

36
Q

List a Nitroimidazole/Anti-protozoal.

A

Metronidazole

37
Q

What does Metronidazole treat?

A
  • Antibiotic
    ~ Clostridium difficile
    ~ H.pylori
    ~ Anaerobic bacteria
    ~ Used in surgeries for GI and GU
    ~ Vaginal, abdominal, colorectal
  • Antiprotozoal
    ~ Trichomoniasis
    ~ Giardiasis
38
Q

What are the mechanisms of Metronidazole?

A
  • Damages DNA in anaerobic organisms
  • Bactericidal
39
Q

What are some adverse effects of Metronidazole?

A
  • Disulfiram-like reaction with EtOH
    > Recent data calls this into question
  • GI Symptoms (most antibiotics do this)
    > N/V/D
    > Metallic Taste (10%)
  • CNS
    > Seizures, ataxia, vertigo, Headache (18%)
  • Rare, but serious
    > Seizures, Peripheral Neuropathy
  • Urine discoloration
    > Darkens the urine
40
Q

What are the nursing considerations for Metronidazole?

A
  • Monitor for CNS symptoms:
    ~ Patients should report any neuropathy or seizures
    ~ No Alcohol!!!! Patients will vomit
41
Q

List a type of Sulfonamide.

A

Sulfamethoxazole-Trimethoprim

42
Q

What do Sulfonamides treat?

A
  • UTIs- E.coli
  • Respiratory Tract Infections
  • coverage for CA-MRSA
  • HIV patients -prophylactic or active treatment of:
    > Pneumocystis jiroveci/carinii Pneumonia (PJP/PCP)
43
Q

What are the adverse effects of Sulfonamides?

A
  • Blood dyscrasias- PANCYTOPENIA- dec WBC, RBC, plts
  • Kernicterus in newborns - avoid in pregnancy and infants
    ~ Excessive bilirubin- neurologic damage
  • Renal crystallization rare- adequate hydration
  • Hyperkalemia (trimethoprim component)
  • Hypersensitivity Reactions
    ~ Photosensitivity (SUNLIGHT)
    ~ Rash/FEVER
    ~ Stevens-Johnson Syndrome/TEN (rare)
44
Q

When should Sulfonamides be avoided?

A
  • Pregnancy (last 2 months)
  • Breastfeeding, Infants
  • SULFA ALLERGY- what other drugs???
  • Don’t forget this causes kernicterus
45
Q

List examples of Fluoroquinolones.

A

Levofloxacin and Ciprofloxacin

46
Q

What do Fluoroquinolones treat?

A
  • Broad Gram +/- coverage
  • Each drug has its own special coverage and they are NOT interchangeable
47
Q

What is the mechanism of action of Fluoroquinolones?

A

Bactericidal
- Inhibit bacterial DNA gyrase and topoisomerase IV

48
Q

What are the adverse effects of Fluoroquinolones?

A
  • Tendon rupture/tendonitis
  • Exacerbates Myasthenia Gravis
  • Peripheral neuropathy, potentially irreversible
  • CNS mental health disturbance
  • QT prolongation
  • Photosensitivity (phototoxicity)
49
Q

What are some nursing considerations for Fluoroquinolones?

A
  • Avoid in Myasthenia Gravis
  • Patients should report any s/s of tendon/joint pain
  • Patients should report any peripheral neuropathy (numbness, tingling, burning)
  • Patients and family should monitor for CNS events
  • Monitor EKG for QT prolongation (caution in cardiac hx)
  • Patients should be instructed to avoid sun exposure
  • Patients should report any s/s of supra-infection (yeast infections, excessive diarrhea)
  • Patients should avoid cations (6 hour prior, 2 hour after window)
  • RISKS vs BENEFITS
50
Q

What does Phenazopyridine treat?

A

Relieve lower urinary tract symptoms (NOT AN ANTIBIOTIC)

51
Q

What is the mechanism of Phenazopyridine?

A

An azo dye that exerts local anesthetic or analgesic action on urinary tract mucosa through an unknown mechanism

52
Q

What are some adverse effects of Phenazopyridine?

A

It is a DYE! It tends to stain urine to an orange-reddish color

53
Q

Describe antibiotic infusions

A
  • In general, antibiotics are very irritating to veins
  • Do NOT infuse with other fluids/drugs
  • Always go SLOW with infusions
  • Always use a DILUTED solution (pharmacy typically does this)
  • Always choose a LARGE vein
    > Avoid small veins
  • Always monitor IV sites- immediately stop if patient reports pain- don’t want to risk extravasation
54
Q

Abx for Acute Otitis Media

A

Amoxicillin or Amoxicillin-Clavulanic Acid

55
Q

Abx for MRSA

A

Vancomycin (IV)

56
Q

Abx for C. Diff

A

Vancomycin (oral), metronidazole

57
Q

Abx for most surgeries

A

Prophylactic antibiotics= Cefazolin

58
Q

Abx for heart valves + dental procedure

A

Amoxicillin

59
Q

Abx for STD/STI

A

Ceftriaxone

60
Q

Abx for Pseudomonas

A

Aminoglycosides, Carbapenems, FQs, Some “cefs”

320 Pharmacology (36 decks)

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