Infectious Diseases Pt. 2 Flashcards
List an example of a glycopeptide.
vancomycin
What is vancomycin used to treat?
- Gram + only
- MRSA (IV only)
- Clostridium difficile (C.diff) (PO only)
- pneumonia, meningitis, osteomyelitis, UTIs, sepsis, etc.
What are the big three adverse effects of vancomycin?
- Nephrotoxicity
- Ototoxicity
- Histamine release / flushing syndrome
What should you monitor if patient has nephrotoxicity?
SCr/BUN, vancomycin levels (troughs)
Describe ototoxicity.
- Rare and potentially reversible
- Vestibular damage- dizziness/balance
- Cochlea- hearing, tinnitus (ringing in ears), fullness in ears
Describe Vancomycin Infusion Reaction / histamine release / flushing syndrome.
- Formerly (and still called) “Red Man Syndrome”
- (via mast cell degranulation)
- Rash, Itching, Flushing
- Tachycardia, Hypotension
Which drugs does vancomycin have drug interactions with?
- Big concern- other nephrotoxic drugs
- Also- other ototoxic drugs
What should you be monitoring if a patient is on vancomycin?
- SCr/BUN
- Vancomycin trough levels: 10-20mcg/mL
Describe nursing considerations for Vancomycin Infusion Reaction/ Red Man Syndrome/ Histamine Flush.
- Make sure it is sufficiently diluted (1 gm/hr)
- Usually caused by too RAPID of infusion- SLOW IT DOWN (at least over 60 minutes)
Describe nursing considerations for ototoxicity.
Assess for hearing loss, monitor drug levels, encourage patients to report hearing or vestibular changes
Describe nursing considerations for nephrotoxicity.
- Assess kidney function- HOW?
- Check trough levels, range- appropriately drawn?
- REVIEW- PEAK and TROUGH DRAWING TIMES
How should you administer vancomycin?
- 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)
List the types of macrolides.
[ACE] Azithromycin, Clarithromycin , Erythromycin, (Clindamycin)
What are macrolides used to treat?
- 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)
What is the mechanism of action of macrolides (Azithromycin, Erythromycin)?
- Inhibit protein synthesis by binding to the 50s ribosomal subunit
- Appear to have anti-inflammatory properties
What are some adverse effects of macrolides (Azithromycin, Erythromycin)?
- 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!
Describe some drug-drug interactions of macrolides (Azithromycin, Erythromycin).
- 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
How should you administer macrolides?
ALWAYS FINISH THE ENTIRE COURSE OF THERAPY (EVEN IF SYMPTOMS IMPROVE EARLY!)
List examples of tetracyclines.
Doxycycline, Minocycline, Demeclocycline
What are tetracyclines used to treat?
- Acne- topical and oral preparations
- Lyme Disease
- Mycoplasma pneumoniae (CAP)
- H. pylori (peptic ulcer disease)
- Rocky Mountain Spotted Fever (Rickettsia diseases)
- Chlamydia
- Anthrax
What is the mechanism of action of tetracyclines?
Bind to the 30s ribosomal subunit, inhibits binding of transfer RNA to messenger RNA-ribosome complex
What are some adverse effects of tetracyclines?
- GI problems
- Hepatotoxicity in large doses
- Photosensitivity
- Tooth discoloration
- Can suppress bone growth in infants
- Risk for super infection / overgrowth
Describe adverse effects of tetracyclines. [GI]
- 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
Describe adverse effects of tetracyclines. [Calcium]
- BINDS TO CALCIUM- TOOTH DISCOLORATION
~ Avoid Calcium products
~ DO NOT GIVE TO CHILDREN, PREGNANT PATIENTS
Describe adverse effects of tetracyclines. [Growth]
- 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
What are some drug-drug interactions of tetracyclines?
- calcium, iron, magnesium, aluminum products
~ separate administration times
~ Take on empty stomach (full glass of water) - Oral Contraceptives and Warfarin
Describe administration of tetracyclines.
- ALWAYS FINISH THE ENTIRE COURSE OF THERAPY (EVEN IF SYMPTOMS IMPROVE EARLY!)
- Take with FULL GLASS OF WATER, AVOID BEDTIME, AVOID CALCIUM!
Describe contra-indications / avoid in of tetracyclines.
- Pregnant Women
- Nursing Women
- Children < 8 years old
List types of Aminoglycosides.
Gentamicin, Tobramycin, Neomycin, Amikacin
What do Aminoglycosides treat?
- 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
What are the mechanisms of Aminoglycosides?
Disrupts protein synthesis by binding to 30s ribosomal subunit, believe to inhibit protein synthesis and promote production of abnormal proteins (post-antibiotic effect)
What are the adverse effects of Aminoglycosides?
-
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
What should you not mix with Aminoglycosides?
Penicillin (in same syringe or IV site)
What time to draw to check for adverse effects of Aminoglycosides (PEAKS)?
1/2 hour after infusion time is over
What time to draw to check for adverse effects of Aminoglycosides (TROUGHS)?
1/2 hour before the drug is due
List a Nitroimidazole/Anti-protozoal.
Metronidazole
What does Metronidazole treat?
- Antibiotic
~ Clostridium difficile
~ H.pylori
~ Anaerobic bacteria
~ Used in surgeries for GI and GU
~ Vaginal, abdominal, colorectal - Antiprotozoal
~ Trichomoniasis
~ Giardiasis
What are the mechanisms of Metronidazole?
- Damages DNA in anaerobic organisms
- Bactericidal
What are some adverse effects of Metronidazole?
- 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
What are the nursing considerations for Metronidazole?
- Monitor for CNS symptoms:
~ Patients should report any neuropathy or seizures
~ No Alcohol!!!! Patients will vomit
List a type of Sulfonamide.
Sulfamethoxazole-Trimethoprim
What do Sulfonamides treat?
- UTIs- E.coli
- Respiratory Tract Infections
- coverage for CA-MRSA
- HIV patients -prophylactic or active treatment of:
> Pneumocystis jiroveci/carinii Pneumonia (PJP/PCP)
What are the adverse effects of Sulfonamides?
- 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)
When should Sulfonamides be avoided?
- Pregnancy (last 2 months)
- Breastfeeding, Infants
- SULFA ALLERGY- what other drugs???
- Don’t forget this causes kernicterus
List examples of Fluoroquinolones.
Levofloxacin and Ciprofloxacin
What do Fluoroquinolones treat?
- Broad Gram +/- coverage
- Each drug has its own special coverage and they are NOT interchangeable
What is the mechanism of action of Fluoroquinolones?
Bactericidal
- Inhibit bacterial DNA gyrase and topoisomerase IV
What are the adverse effects of Fluoroquinolones?
- Tendon rupture/tendonitis
- Exacerbates Myasthenia Gravis
- Peripheral neuropathy, potentially irreversible
- CNS mental health disturbance
- QT prolongation
- Photosensitivity (phototoxicity)
What are some nursing considerations for Fluoroquinolones?
- 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
What does Phenazopyridine treat?
Relieve lower urinary tract symptoms (NOT AN ANTIBIOTIC)
What is the mechanism of Phenazopyridine?
An azo dye that exerts local anesthetic or analgesic action on urinary tract mucosa through an unknown mechanism
What are some adverse effects of Phenazopyridine?
It is a DYE! It tends to stain urine to an orange-reddish color
Describe antibiotic infusions
- 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
Abx for Acute Otitis Media
Amoxicillin or Amoxicillin-Clavulanic Acid
Abx for MRSA
Vancomycin (IV)
Abx for C. Diff
Vancomycin (oral), metronidazole
Abx for most surgeries
Prophylactic antibiotics= Cefazolin
Abx for heart valves + dental procedure
Amoxicillin
Abx for STD/STI
Ceftriaxone
Abx for Pseudomonas
Aminoglycosides, Carbapenems, FQs, Some “cefs”
