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Collab Therapies 2 > Infective Disease 1 Meds Questions > Flashcards

Infective Disease 1 Meds Questions Flashcards

1
Q

Explain the rationale behind the use of the mix of tazobactam with piperacillin.

A

Tazobactam is a beta lactam inhibitor that stops the bacteria from producing the enzymes that can prevent penicillin from working effectively.
- B lactam inhibitors can be effective toward gram positive bacteria

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2
Q

What assessments does the nurse need to do prior to starting the antibiotic? What tests would she anticipate would need to be done prior to starting antibiotics?

A

Assessments:

  • Full VS
  • check IV site and latency

Tests:

  • culture and sensitivity
  • renal and hepatic function tests (bc of warfarin and antibiotic excretion)
  • allergies before starting
  • CBC and PTT
  • electrolyte imbalances
  • if women : use of any oral contraceptives
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3
Q

What are some signs that the antibiotic therapy is effective?

A
  • WBC count is decreased

- improvement of symptoms

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4
Q

What assessments are needed before starting a vancomycin infusion?

A
  • culture and sensitivity
  • Kidney tests (BUN, GFR, creatinine clearance, albumin creatinine ratio, serum creatinine, urine test)
  • VS
  • assess for hearing function (due to risk of AE of hearing loss)
  • baseline neuro assessment
  • baseline weight
  • KDA
  • other meds taken by pt for any drug interactions
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5
Q

Two days after starting a vancomycin infusion, the patient reports feeling hot and itchy in his face and neck, these areas are flushed, what AE reactions do you expect is happening?

What might be a possible treatment?

A

Red man syndrome which is an infusion reaction to vancomycin.
(Antihistamines may be given and the infusion rate will be slowed -> not life-threatening)

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6
Q

What is a possible AE of a too rapid vancomycin infusion?

A

If the infusion of vancomycin is too rapid, it may cause hypotension or red man syndrome (flushing itching of head face neck upper trunk)

It should be infused over at least 60min.

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7
Q

What are some actions that can minimize complications and AE during the vancomycin infusions?

A
  • monitor trough levels 30min before next dose
  • Check for infiltration and phlebitis
  • instruct pt to drink at least 2L of water per day
  • infuse over at least 60min
  • assess for signs of Red man syndrome (flushing/itching of head, neck, face, upper trunk)
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8
Q

What is the therapeutic goal of vancomycin levels when the levels of monitored?

A

The levels should be between 10-20mcg/ml for therapeutic goal

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9
Q

What is an important patient teaching taking oral contraceptives starting an antibiotic therapy?

A
  • switch to a non oral form of oral contraception (without hormone) as the antibiotic can lead it to be less effective
  • avoid or use additive protection against sun as it can cause photosensitivity reactions
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10
Q

What are some nursing implications with sulfonamides ?(prototype med: sulfamethoxazole and trimethoprim often given together : proxim or septra)

A
  • take with at least 2L of fluid per day (water) to protect kidneys
  • oral forms should be taken with food or milk to decrease GI upset (decrease AE)
  • take appropriate protection in the sun due to photosensitivity risk.
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11
Q

What are some interactions with sulfonamides (septra, proxim)?

A
  • can potentate hypoglycemic effects of sulfonylurias in diabetes
  • can increase toxic effects of phenytoin (anti epileptic med)
  • can increase anticoagulant effect of warfarin (increase risk of hemorrhaging)
  • increase risk of cyclosporine-induced nephrotoxicity
  • decrease immunosuppressants effects of cyclosporine
  • decrease oral contraceptives effectiveness
  • increase risk of anemia in pt with G6PD deficiency
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12
Q

What are the three categories of B-lactam antibiotics and their prototype medication?

A
  1. Penicillin — amoxicillin (Amoxil)
  2. Cephalosporins — cefazolin (Ancef) (1rst gen), cefuroxime (2nd gen), ceftriaxone (Rocephin) (3rd gen), cefepime (4th gen)
  3. Carbapenems — imipenum/ cilastatin (Primaxin)
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13
Q

What is the only form of septra/proxim available? (Sulfonamides)

A

Only available as injections.

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14
Q

How do sulfonamides (Protrim, Septra) work?

A

Work by inhibiting the bacteria growth (bacteriostatic antibiotic)
- prevent bacterial synthesis of folic acid

Also considered antimetabolites since they block a step in the bio synthetic pathway.

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15
Q

Are sulfonamides (Protrim and Septra) safe in pregnant women ?

A

No, they are contraindicated in pregnant women at term and in infants younger than 2months of age.

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16
Q

What is the mechanism of action shared in the B-lactam antibiotics (Penicillins, cephalosporins, carbapenems)?

A

They work by inhibiting the synthesis of the bacterial peptidoglycan cell wall.
Bactericidal antibiotics

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17
Q

Why are B-lactamase inhibitors drugs often added to a penicillin antibiotic treatment?

A

Because some bacterias have developed a resistance to the B-lactam antibiotics allowing them to be able to break the B-lactam ring and inactivate the antibacterial efficacy of the drug, so the B-lactamase inhibitors prevent those bacteria from breaking the b lactam ring (by inhibiting the enzyme) and the medication is than stronger and able to kill the bacteria.

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18
Q

What are the most common AE with cephalosporins ?

A
  • mild diarrhea
  • abdominal cramps
  • rash
  • pruritus (itching)
  • redness
  • edema

And risk of nephrotoxicity

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19
Q

Are cephalosporins safe to use in pregnancy?

A

Yes.

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20
Q

Which is the only antibiotic in the cephalosporin category available PO?

A

2nd generation cephalosporin: Cefuroxime available PO, IV and IM

  • 1st gen: Cefazolin only IV or IM
  • 3rd gen: Ceftriaxone only IV or IM
  • 4th gen: Cefepime only IV or IM

Other category: Penicillin (amoxicillin only PO)

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21
Q

What are some indications for carbapenems (imipenem/cilastatin = Primaxin)?

A

Often reserved for complicated body cavity and connective tissue infections.
- tx of bone, joint, skin and soft tissue infections

Also effective in gram positive organisms.

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22
Q

What are some med interactions that can occur with the carbapenem Primaxin (Imipenem/cilastatin)? And what is the risk of those interactions?

A

Drugs that can increase the CNS AE and increase risk of seizures caused by Imipenem include:

  • cyclosporine (immunosuppressant)
  • ganciclovir (antiviral med)
  • probenecid
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23
Q

What is the prototype medication for macrolides? And what are the forms available?

A

Erythromycin

Available PO, IV or topical

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24
Q

What is the mechanism of action of macrolides antibiotics (Erythromycin)?
And what are the indications for this medication?

A

They inhibit protein synthesis. (Bacteriostatic)

Tx of upper and lower respiratory infections, skin and soft tissue infections
Used in Lyme disease and gonorrhea.

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25
Q

What other use can erythromycin bring that is not related to infections?

A

Erythromycin is known for its ability to irritate the GI tract stimulating the smooth muscle and GI motility.
Therefore it is sometimes used for pts having a decreased GI motility (delayed gastric emptying for example in pts with diabetes)

  • also shown to be helpful in facilitating the passage of feeding tubes from stomach to small bowel.
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26
Q

What are the most common AE of erythromycin?

A
  • N & V
  • GI adverse effects
  • lower GI complications

Others:

  • palpitations, chest pain, QT prolongation
  • GI bleeds
  • headache, dizziness, vertigo
  • hepatotoxicity, heartburn, diarrhea, flatulence, anorexia, abnormal taste
  • rash, urticaria, phlebitis at IV site
  • hearing loss, tinnitus (ototoxicity)
27
Q

What are some serious drug interactions that can occur with erythromycin and why?

A

Because: metabolized in liver and highly protein bound = decrease metabolism so longer time in body = increased chance of toxicity with:

  • carbamazepine
  • cyclosporine
  • digoxin
  • theophylline
  • warfarin

Other interactions:
- decrease effectiveness of oral contraceptives

28
Q

What is the prototype medication for the tetracycline category of antibiotics?

A

The prototype medication is Doxycycline (Doxycin)

29
Q

What are the use of Doxycycline (Doxycin)? (Tetracycline med) and how does it work?

A 
Used to treat : 
- rickettsia infection
- c. Diff
- chlamydia
- mycoplasma infections 
- spirochetal infections
And Other gram negative organisms

Works by:
Inhibiting bacterial protein synthesis, inhibit bacterial growth and kills organism
(Bacteriostatic)

30
Q

Important food interaction with the tetracycline Doxycycline.
And contraindications due to that interaction.
And other interactions.

A

Doxycycline binds to Ca+ and Mg+ which decreases the medication absorption so taking milk, antacids or iron salts will strongly reduce oral absorption of the medication.

Because of that fact, it is also contraindicated in :

  • children younger than 8 years old for risk of tooth discoloration
  • pregnant or nursing mothers

Other interactions:

  • antidiarrheal drugs, calcium enteral or oral feeds can also decrease oral absorption
  • increase effet of oral anticoagulant (warfarin)
  • decrease effect of oral contraceptives
31
Q

What are some adverse effects of Doxycycline?

A
  • tooth discoloration
  • photosensitivity
  • complications on fetuses
  • alteration in intestinal flora which can cause diarrhea yeast infections or in extreme cases superinfections or vaginal candidiasis
32
Q

What are some nursing implications for tetracyclines (Doxycycline)?

A
  • avoid taking mild products, dairy products, iron preps, antacids
  • take with 180-240mLs of water
  • avoid sunlight and tanning beds due to photosensitivity
33
Q

Assessments/tests to do before starting sulfonamides (sulfamethoxazole/septra) therapy specifically? And for any antibiotic?

A
  • drug allergies
  • thorough skin assessment before and during drug therapy (bc of risk of stevens Johnson)
  • assess red blood cell counts (due to risk of anemia)
  • assess kidney function (due to potential drug related crystalluria)
  • list of all medications taken by pt even OTC

For any antibiotic:

  • drug allergy
  • pt history
  • pt medication list
  • pt age
  • pt baseline weight
  • pt baseline VS
  • liver function tests (AST and ALT)
  • kidney function tests (GFR, BUN and creatinine levels usually maybe more if any known kidney problems)
  • culture and sensitivity
  • heart function tests (ECG)
  • CBC with hemoglobin and hematocrit levels
  • platelet and clotting tests
  • intake and output measurements
  • baseline neuro exam due to possible CNS AE
  • bowel sounds and patterns due to GI upset related AE
34
Q

Specific assessments to do prior to starting penicillin antibiotic therapy?

A
  • drug allergies (also cross sensitivity) —> so any reactions to cephalosporins as well
  • history of asthma, sensitivity to many allergens, aspirin allergy = higher risk of penicillin allergy
  • complete neuro and GI exam bc of risk of CNS and GI AE
  • assess for electrolyte imbalances (especially sodium and potassium in pts with heart or kidney disease bc of high sodium and potassium ion in some penicillin preps)
35
Q

Specific assessments prior to starting carbapenems therapy?

A

Assess for history of seizures due to AE of seizures

36
Q

Specific assessments needed prior to starting macrolides (Erythromycin) therapy?

A
  • assessment of baseline heart function (VS) due to risk of palpitations, chest pain and ECG changes (QT prolongation)
  • assess baseline hearing status due to drug induced hearing loss and tinnitus
  • assess liver function and past disease (due to possible hepatotoxicity and jaundice)
37
Q

Mr. C is receiving an IV antibiotic therapy, the therapy was starting 35minutes ago so you go back in the room to check on the patient. You notice the patient seems to have difficulty breathing, he states feeling itchy and you notice his face is slightly swelled.

You recognize a hypersensitivity reaction what will be your 3 top priority actions?

A
  1. Stop the infusion
  2. Ensure the patient is able to breathe
  3. Call the health care provider to know what to do next
38
Q

What are some of the signs and symptoms of a hypersensitivity reaction ?

A
  • SOB
  • wheezing
  • swelling of the face, tongue or hands (angioedema)
  • itching or rash
39
Q

What are some important teaching points with cephalosporins therapy?

A
  • take PO med with food to decrease GI upset AE

- alcohol and alcohol containing products are to be avoided —> may cause acute alcohol intolerance

40
Q

A pt who has been hospitalized for 2 weeks has developpee a pressure ulcer that contains methicillin-resistant staphylococcus aureus (MRSA). Which antibiotic does the nurse expect will be chosen for his therapy?

A. Penicillin
B. Nitrofurantoin (Macrobid)
C. Vancomycin (vancocin)
D. Clindamycin (Dalacin C)

A

C.

41
Q

When completing an admission assessment, the pt reports being allergic to sulpha drugs. What will the nurse do next?

A) mark the allergy on the patient’s medical record
B) place an «allergy» armband on the pt
C) ask the pt for more information about the allergic reaction
D) notify the physician about the pt’s allergy

A

C)

42
Q

When performing discharge teaching for a pt prescribed oral linezolid (Zyvomax) to treat VRR, the nurse should emphasize which importsnt instruction?

A) stop the drug as soon as you feel better
B) avoid ingesting foods that contain thyramine
C) report any occurrence of constipation or facial flushing.
D) take the drug with an antacid to avoid GI upset

A

B)

43
Q

Which is an AE of vancomycin IV infusions?

A) angioedema
B) neurotoxicity
C) cardiomyopathy
D) Red man syndrome

A

D)

44
Q

During IV quinolone therapy on an 88 yr old pt which potential problem is of most concern when the pt is being assessed for AE?

A) hepatotoxicity
B) rhabdomyolysis
C) tendon rupture
D) nephrotoxicity

A

C)

45
Q

Which nursing diagnosis is appropriate for the pt who has started aminoglycoside therapy?

A) constipation
B) risk for injury (hearing loss)
C) disturbed body image related to gynecomastia
D) imbalanced nutrition, less than body requirements related to nausea

A

B)

46
Q

Which does the nurse identify as being a concern for pts receiving tetracycline (Doxycycline)?

A)tetracycline should not be administered to anyone older than age 65years.
B) tetracycline has no impact on the effectiveness of oral contraceptives
C) tetracycline used with warfarin decreases warfarin’s effectiveness and enhances clot formation
D) tetracyclines should not be administered with dairy products.

A

D)

47
Q

Identify the class of antibiotic which is often used with B-lactam inhibitors to extend the effectiveness of the antibiotics.

A) penicillins
B) tetracyclines
C) sulfonamides
D) macrolides

A

A)

Amoxicillin most often

48
Q

Which drug may result in an interaction if taken with penicillin?

A) antacids
B) acetaminophen
C) digoxin (Lanoxin)
D) warfarin (coumadin)

A

D)

49
Q

What are some lab tests that need to be monitored with antibiotic therapy?

A

Blood tests:
- creatinine clearance
- BUN
- GFR
- trough levels
- peak levels
- liver functions (AST, ALT)

Urine culture and sensitivity
Swab topically culture and sensitivity

50
Q

What is the trough level?

A

The lowest concentration of medication in the blood done 30min before next dose

Used to determine how much medication was absorbed,
Goal: usually at or below 1mcg/mL anything would increases risk of nephrotoxicity or ototoxicity

51
Q

What are some contraindications with sulfonamides antibiotics (sulfamethoxazole(septra))?

A
  • pregnant women
  • infants younger than 2 months
  • KDA
52
Q

What are some toxicities associated with sulfonamides antibiotics (septra)?

A
  • anaphylaxis
  • nephrotoxicity
  • thrombocytopenia
  • hepatotoxicity
  • cystalluria
  • allergic reactions
  • photosensitivity
53
Q

Which drug may result in an interaction if taken with penicillin (amoxicillin)?

A) antacids
B) acetaminophen
C) digoxin
D) warfarin

A

D) warfarin because amoxicillin (amoxil) decreases vitamin K in the gut

54
Q

A pt has a prescription for a sulphate drug as tx for a UTI. She is also taking an oral contraceptive, an oral sulfonyurea antidiabetic drug, and phenytoin for hx of seizures. Which drug may pose a potential serious interaction with the sulpha drug?

A) oral contraceptives
B) oral antidiabetic
C) phenytoin
D) All Of the above

A

D

55
Q

Identify the class of antibiotics which is often used with b lactamase inhibitors to extend the effectiveness of the antibiotics?

A) penicillins
B) tetracyclines
C) sulfonamides
D) macrolides

A

A

56
Q

Which does the nurse identify as being a concern for pts receiving tetracycline?

A) tetracycline should not be administered to anyone older than 65 years old
B) tetracycline has no impact on the effectiveness of oral contraceptives
C) tetracycline used with warfarin decreases warfarin’s effectiveness and invented clot formation.
D) tetracycline should not be administered with dairy products

A

D

Tetracycline antibiotic = doxycycline (Doxycin)

57
Q

What are some AE of tetracycline? (Doxycycline)

A
  • discoloration of teeth in children and fetuses
  • stunt fetal growth
  • photosensitivity
  • vaginal and oral candidiasis
  • diarrheal yeast infections
58
Q

What elements should be avoided with the use of tetracycline antibiotic (doxycycline)?

A
  • antacids
  • antidiarrheals
  • iron salts
  • calcium enteral feeds
  • dairy products
59
Q

Which nursing diagnosis is appropriate for the pt who has started aminoglycoside therapy?

(Gentamicin)

A) constipation
B) risk for injury (hearing loss)
C) disturbed body image related to gynecomastia
D) imbalanced nutrition, less than body requirements related to nausea

A

B

60
Q

During IV quinolone therapy (ciproflaxin) on an 88 year old pt, which potential problem is of the most concern when the pt is being assessed for AE?

A) hepatotoxic y
B) rhabdomyolysis
C) tendon rupture
D) nephrotoxicity

A

C

61
Q

When completing an admission assessment, the pt reports being allergic to sulpha drugs. What will the nurse do next?

A) mark the allergy on the pt’s medical record
B) place an «allergy» armband on the pt
C) ask the pt for more information about the allergic reaction
D) notify the physician about the pt’s allergy

A

C

62
Q

A pt who has been hospitalized for 2 weeks has developed a pressure ulcer that contains MRSA. Which antibiotic does the nurse expect will be chosen for this therapy?

A) penicillin
B) Nitrofurantoin (macrobid)
C) vancomycin (vancocin)
D) clindamycin (dalacin)

A

C

63
Q

Which antibiotics (2) needs to be giving on an empty stomach?

A

Ciproflaxin (cipro) and clindamycin

Amoxicillin can be taken with or without but best taken without

64
Q

Thé nurse would question a prescription for voriconazole (vfend) if the pt we’re taking which medication?

A ) quinidine
B) prednisone
C) captopril
D) clindamycin

A

A

Collab Therapies 2 (28 decks)

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