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NRSG 213 > Lecture 7 > Flashcards

Lecture 7 Flashcards

1
Q

what is an infection? (2 definitions)

A

1) invasion of bacteria, virus, or fungus (transient)

2) overgrowth of normal microbiota in a compromised host

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2
Q

bacteria, fungi, protozoa, and viruses all cause infections, but…

A

each must be treated differently.

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3
Q

ideally, an anti-infective should…

A

1) kill the specific organism
2) not kill the normal flora
3) have no side effects

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4
Q

in reality, the process of getting an anti-infective is more like…

A

1) MD will administer a broad-spectrum antiinfective before cultures come in
2) try to get to a therapeutic level of the medication ASAP
3) kill the infection without too many side effects
4) may switch to a narrow-spectrum antiinfective
5) may give other medications to counteract the loss of normal flora

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5
Q

Goal of antiinfective therapy

A

prevent infection when there is high risk of contamination….

  • before surgery
  • with severe injury
  • with a dirty wound
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6
Q

Four biggest side effects of antibiotics

A

1) allergy (mild to severe)
2) resistance (mutation of organism)
3) superinfection
- type 1: normal flora disturbed
- type 2: bacteria invaded because immune system busy fighting something else
4) GI upset

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7
Q

Age and situation related s/e (young/old/pregnant people)

A

very young: no tetracycline, thus malformed/discolored bones

very old: may need smaller dose d/t impaired liver function

pregnant people: some antiinfectives are teratogenics

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8
Q

seven patient teaching points – antiinfectives

A

1) take the whole prescription
2) don’t share medications with others
3) don’t have/keep allergies
4) if allergic, wear a medical alert tag
5) contact HCP if you get rash, respiratory problems, edema around face, diarrhea longer than 1 day
6) antibiotics interfere with oral birth control
7) you should see improvements in 24-48 hrs

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9
Q

bactericidal

A

antibiotics that kill bacteria

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10
Q

bacteriostatic

A

antibiotics that inhibit bacterial growth

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11
Q

gram postive cocci

A

round bacteria with thick peptidoglycan walls

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12
Q

gram negative cocci

A

round bacteria with more complex cell walls (double lipid layers)

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13
Q

anaerobic/aerobic

A

I feel like you don’t really need this flashcard man

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14
Q

CATEGORIES OF ANTIBACTERIALS

A

1) Sulfonamides
2) Penicillins
3) cephalosporins
4) carbapenems
5) macrolides
6) tetracyclines
7) aminoglycosides (stronger)
8) quinolones
9) miscellaneous

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15
Q

Sulfonamide action

A

inhibit synthesis of folic acid used for bacterial growth

Bacteriostatic

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16
Q

Sulfonamide uses

A
  • UTIs
  • combined for best fx with others; many bacteria are now resistant
  • useful for treating MRSA
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17
Q

sulfonamide contraindications

A

few

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18
Q

Sulfonamide Medication

A

Sulfamethoxazole (Bactrim)

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19
Q

Penicillins (made from mold) actions

A

inhibits bacterial wall synthesis (cell breaks down and dies; works mostly on gram positive bacteria)

Bactericidal

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20
Q

Penicillin problems

A
  • many bacteria have mutated and now produce beta-lactamase, which destroys penicillin
  • combination meds may be used to inhibit
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21
Q

Penicillin uses

A

broad spectrum medications; often used for pneumonia and ear infections

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22
Q

Penicillin contraindications

A

many people are allergic, esp those with asthma

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23
Q

Penicillins medication…

A

Penicillin G

Ampicillin

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24
Q

Cephalosporin (synthetic) action

A

inhibits bacterial wall synthesis; very chemically similar to penicillin

bactericidal

works on gram pos, gram neg, and some anaerobic bacteria

5 dfferent generations

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25
Q

Cephalosporins side effects, contraindications

A

s/e: diarrhea

contraind: allergies to penicillin (cross-sensitivity)

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26
Q

Cephalosporin uses

A

UTIs, strep throat

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27
Q

Cephalosporin medications

A

Cefazolin (Ancef)

Cefoxitin (Mefoxin) - good for anaerobic

28
Q

Carbapenems action

A

inhibits cell wall synthesis (broadest action of all current antibiotics)

Bactericidal

29
Q

Carbapenem s/e and contraindications

A

s/e: medication-induced seizures (not common)

contraind: if severely allergic to penicillin, may be allergic to these too

30
Q

Carbapenem uses

A

reserved for complex organ, body cavity, or connective tissue infections.

only given IV or IM; infused over 60 min if IV

31
Q

Carbapenem medication

A

Imipenem-Cilastatin (Primaxin)

Imipenem = antibiotic
Cilastatin = inhibits quick breakdown of antibiotic by kidneys
32
Q

Macrolide actions

A

inhibits protein synthesis, binding to ribosomes

Bacteriostatic

33
Q

Macrolide problem

A

easily destroyed by HCl (usually coated)

34
Q

Macrolides uses

A

respiratory infections
Lyme disease
STIs

35
Q

s/e and interactions of Macrolides

A

s/e: can cause severe GI disturbance

interactions: several common medications

36
Q

Macrolide medications

A

Erythromycin (give with food)

Azithromycin (Zithromax)

37
Q

Tetracycline actions

A

inhibits protein syntehsis by binding with ribosomes (blocks RNA nad mRNA from communicating)

Bacteriostatic

Good for variety of gram pos and neg organisms
Also good for org w/o cell wall (mycoplasma)

38
Q

Tetracycline administration problems

A
  • binds especially well with calcium, magnesium, iron
  • if given with milk, antacids, or iron, tetracycline doesn’t work
  • also binds with calcium in the blood
  • should not be given to children under age 8
  • not given to pregnant women
  • not fiven if breastfeeding
  • causes tooth discoloration, lack of enamel growth on teeth, and delayed/slowed fetal skeletal development
39
Q

Tetracycline uses

A
  • STIs
  • acne control
  • Lyme disease
  • peptic ulcer disease (H. pylori)
40
Q

Tetracycline medication to remember

A

Doxycycline

41
Q

Aminoglycosides actions

A

binds to ribosomes and prevents protein synthesis in bacteria

bactericidal

Very strong; mostly used for gram negative infections

42
Q

Aminoglycosides uses

A

for severe systemic infections (given in combination)

43
Q

Aminoglycosides s/e and contraind

A

s/e:
- ototoxicity (CN VII)
- nephrotoxicity (renal failure)
monitor BUN for kidney fn, monitor for hearing loss

contraind:
neonates, pregnant peopls, breastfeeding people
interacts with man kinds of meds; toxicity is a significant concern

44
Q

Aminoglycoside to know

A

Gentamicin

45
Q

Quinolones (fluoroquinolones) action

A

interferes with enzyme needed to produce DNA

bactericidal; mostly for gram negative

46
Q

Quinolone uses

A

UTIs, skin infections, bone/joint infections, anthrax

47
Q

Quinolone to remember

A

Ciprofloxacin (Cipro)

48
Q

Clindamycin action

A

bind to ribosomes and supprsses protein synthesis

semi-synthetic

both bactericidal and bacteriostatic; action depends on the concentration of the medication and the invading bacteria

49
Q

Clindamycin uses

A

UTIs
intra-abdominal infections
anaerobic pneumonia

50
Q

Clindamycin complication/precautions

A

Causes C. diff

use caution in patients receiving neuromuscular blocking agents

51
Q

Vancomycin action

A

Bactericidal

strongest antibiotic we have; toxicity is a concern

52
Q

Vancomycin uses

A

treat Methicillin Resistant Staph Aureus (MRSA)

special labs must be drawn to maintain therapeutic levels

53
Q

Metronidazole (Flagyl) actions

A

destroys bacteria by interfering with an enzume needed to produce bacterial DNA

Bactericidal; esp good or anaerobic organism

54
Q

Flagyl uses

A 
intra-abdominal infections
gynecological infections (anaerobic)
55
Q

Flagyl interactions and precautions

A

interacts badly with several other meds, esp psych meds

alters enzymes needed to metabolize many other meds, give with caution d/t toxicity

56
Q

Avoid the misuse of antibiotics…

A
  • take the full prescription
  • take w 6-8 oz water with each dose
  • don’t take too often (mutation and resistance of bacteria)
  • important to take on time; keep blood level above the therapeutic threshold
57
Q

Antiviral medications actions

A

inhibits ability of virus to replicate

58
Q

why don’t we have very good antivirals?

A
  • by the time symptoms appear w viral infection, virus is done replicating
  • virus replicate niside cells by copying cell’s DNA
  • hard to kill virus w/o killing host cell
59
Q

How do antivirals work?

A

1) enter the cell and interfere with nucleic acid
2) keep the virus from entering cells
3) stimulate immune system to kill virus

60
Q

What viruses do we have some success in treating?

A

Herpes 1 and 2

HIV

Influenza

61
Q

Antiviral s/e

A

very common; do kill some host cells. Lots of interactions with other medications

62
Q

Antibiral meds to know

A

1) Acyclovir (Zovirax) – herpes and chicken pox; cream, tablets, IV; contraind w renal/liver diseases, seizures, pregnancy/breastfeeding, dehydration
2) Zidovudine (AZT) - antiretroviral for HIV; quite toxic, many s/e; contraind w renal/liver diseases, seizures, pregnancy/breastfeeding, dehydration
3) Oseltamivir (Tamiflu) – influenza virus A and B; ideally begin treatment within 2 days of symptoms; oral; most common s/e N/V

63
Q

Antifungal medications action

A

most work by one of these:

1) binds to cell membranes of fungi, leaking out K+ and Mg
2) inhibits mitosis
3) decreases cell reproduction

64
Q

Antifungal uses

A

treatment of molds and yeasts; often these are opportunistic in the immunocompromised
systemic use

65
Q

Common local fungal infections

A
  1. oral candidiasis (thrush)
  2. vaginal yeast infections
  3. athlete’s foot
  4. diaper rash
66
Q

Antifungal to know

A

Nystatin (Mycostatin

- oral and cream

67
Q

Nursing dx r/t antiinffectives

A

risk for infection (superinfection) r/t altered immune status
risk for injury r/t adverse effects
deficient knowledge r/t lack of info/experience w med

NRSG 213 (9 decks)

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