Mod 11- Antibiotics Flashcards
Bacteria whose cell wall lose a stain or are decolorized by alcohol are called _______________
Gram-negative
Gangrene is an example of a(n) _______________ bacteria that do not use oxygen to survive
anaerobic
T/F: Aminoglycosides are an example of antiinfectives that are classified as bacteriostatic
FALSE
Bactericidal- Kill Kill!
A bacterium that depends on oxygen in order to survive is called _______________.
aerobic
The class of drugs that treats infections by inhibiting folic acid synthesis is called _______________.
Sulfonamides (sulfa drugs)
When antibiotics are given in combination so that their combined effects are greater than if they were given individually, they are considered to be _______________.
synergistic
T/F: A Gram stain is used to identify gram-positive bacteria by retaining a stain within its cell wall.
TRUE
T/F: When patients are allergic to penicillin, erythromycin has proven to be an effective alternative.
TRUE: part of the Macrolides
T/F: Fluoroquinolones are used to treat susceptible strains of gram-positive bacteria.
FALSE: most effective for Gam negative
T/F: Cephalosporins can be classified as either bactericidal or bacteriostatic depending on which specific drug and dose are used.
TRUE
What should be done prior to administration of an antibiotic?
A culture MUST BE DONE FIRST
What is important to report to a physician regarding a bacteria sensitivity report?
if a drug is sensitive, resistant, or intermediate (sometimes it does, sometimes it doesn’t)
What harm can antibiotics do to children?
Can damage cartilage, bones, and teeth
esp. tetracycline stains for everyone, but can cause pitting on kiddos
Can tetracycline be used during pregnancy?
NO because it causes damage to cartilage, teeth, and bones
What class of antibiotics affect cartilage?
Fluoroquinolones
What education is important for the parents of a child receiving antibiotics?
Keep administering full course
These only work on bacteria- not allergies & Virus
They have side effects- important to only give when needed
How to store medication- liquids if they need to be in the fridge or room temp
How to give- liquids to shake if in suspension form
Do not save antibiotics
Do not take medication that doesn’t belong to them
T/F: Can antibiotics affect the efficacy of hormonal birth control?
TRUE- barrier contraceptives during & 5 days afterwards
What are older adults more susceptible to with antibiotics?
ADE
Renal & Hepatic impairment
Why is it important to check mental status, orientation, and reflexes for someone taking an antibiotic?
- so they can understand what we are telling them
2. We are checking baseline b/c some drugs have CNS effects
What is ototoxicity?
Damage to the 8th cranial nerve (ears)
What changes in vitals will we see if an antibiotics are working?
Decreased temp as infection clears
clear lung sounds if treating respiratory infections
T/F: Some antibiotics can cause bone marrow depression?
TRUE
What are some safety measures for the CNS effects of an antibiotic?
Fall precautions do not drive toileting schedules non slip socks dim lights for headaches
What are common GI effects of antibiotics?
Nausea, vomiting, diarrhea, stomatitis (inflammation of the mouth)
What nursing interventions should we do for pts taking nephrotoxic drugs do to benefit their kidneys?
Frequent water drinking to keep kidneys flushed
ADE of aminoglycosides:
ototoxicity, nephrotoxicity, and bone marrow suppression
What lab values are for kidneys?
Creatinine and BUN- higher they are, unhappier I am
What implementation do we need for a pt taking aminoglycosides?
Keep them well hydrated
Contraindication of carbapenems?
seizure disorder, inflammatory bowel disorders
ADE of carbapenems:
pseudomembranous colitis and C DIFF diarrhea- more important to remember
Drug-Drug interactions of cephalosporins
aminoglycosides (nephrotoxic so this increases the risk of kidney damage), anticoagulants (can increase bleeding), ETOH
What is an important teaching point for a pt taking cephalosporin?
DO NOT DRINK ALCOHOL, can induce projectile vomiting
What lab value do we monitor for a pt taking an oral anticoagulant?
INR
Fluoroquinolones Drug/ Drug interactions
Antacids, aminoglycosides, quinidine (causes prolonged QT interval, leads to fatal arrhythmia), Theophylline (very small safety range), NSAIDs (increase CNS stimulation- hallucinations)
Black box warning for the fluoroquinolones:
Tendon rupture (achilles tendon)
What should a patient taking fluoroquinolones report to use immediately?
ANY new aches and pains d/t risk for tendon ruptures
What drug class has a cross sensitivity to cephalosporins?
Penicillins
This class of antibiotics is teratogenic
Sulfonamides
Sulfonamides have a cross sensitivity to which other drug class
thiazides (structurally similar)
Which antibiotics do you take on an empty stomach but with a full glass of water?
Sulfonamides & tetracyclines
This class of antibiotics can cause photo sensitivity so education must be given to pt
Tetracyclines
What does LFT stand for for labs?
liver function tests
ADE of lincosamides
c Diff, bone marrow suppression
Clindamycin and lincomycin are examples of what drug class
Lincosamides
“thromycin” drugs are apart of what class?
Macrolides
ADE of “thromycin” drugs?
C diff, hearing loss, liver toxicity
Fidaxomicin is apart of which drug class?
Macrolides
Fidaxomicin treats what:
c Diff in pts 6 mo. and up
Oxazolidinones end in what suffix?
“zolid”
ADE of oxazolidinones
thrombocytopenia, c diff
what is a monobactam medication?
aztreonam
ADE of aztreonam?
GI effects- but less than others
Lipoglycopeptides end in what?
“vancin” and “vancomycin”
ADE of Lipoglycopeptides
Nephrotoxic, foamy urine (warn pt), prolonged QT interval
ADE of Vanco:
Think Very irritating to the Vein
Make sure IV is patent, monitor during infusion
What does the ORAL form of Vanco treat?
c diff
What syndrome is associated with Vanco?
Red Man syndrome
rapid infusion of med
sudden hypotension, flushing, pruritus, red rash on face/ neck chest
Tx- slow down infusion
How is red man syndrome different than anaphylactic reaction?
Anaphylactic has breathing issues and should be stopped immediately
Red man should be slowed down
This is a drug we give for TB:
Rifampin
ADE of Rifampin
TB Drug
Red- fampin: Can turn tears, pee, and things red
Liver toxicity
This is a drug we give for TB:
Isoniazid (INH)
ADE of isoniazid (INH)
TB Drug
interferes w/ absorption of b6
neuropathy- reports of numbing/ tingling
hepatotoxicity
How must TB drugs be administered?
As a combination, never given alone
This drug treats TB
pyrazinamide
This drug treats TB
Ethambutol
ADE of Ethambutol
TB Drug
E=eye
baseline and periodic eye exams
report blurred vision or color changes
This is a drug to treat TB
Streptomycin
How long does TB medication tx last?
6-12 mo.
What TB drugs can a pregnant pt be given?
INH, ethambutol, rifampin
T/F: TB drugs interfere w/ hormonal birth control
TRUE, pt should be taught to use barrier contraceptives
Sulfonamides are bacteriostatic against a wide range of gram-positive and gram-negative bacteria, but they are becoming less useful for what reason?
Increasing resistance
In which condition present in the client should macrolides be used with caution?
Liver dysfunction
After teaching a group of students about carbapenems, the instructor determines the need for additional teaching when the students identify what as an example?
Cefuroxime
Explanation:
Cefuroxime is a cephalosporin. Doripenem, imipenem-cilastatin, and ertapenem are carbapenems
A nurse is caring for a patient who has a serious infection. The patient is being treated with combination therapy of a cefazolin and an aminoglycoside. The nurse will be sure to monitor which of the following?
Serum BUN and creatinine levels
A client is taking clindamycin for an infectious process and presents to the health care provider’s office with symptoms of dehydration. The nurse understands that the client is experiencing what adverse reaction from the administration of clindamycin?
Diarrhea
Explanation:
Clindamycin belongs to the lincosamide class of antimicrobials, similar to macrolides in its mechanism of action and antimicrobial spectrum. A life-threatening adverse effect of clindamycin is the development of pseudomembranous colitis.
What drug belongs to the group of carbapenems?
Primaxin
The nurse is caring for a client whose prescribed course of cefaclor will soon be completed. What health education should the nurse provide to the client?
“Make sure to avoid drinking any alcohol for the next three days.”
A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections?
Rotate injection sites for frequent parenteral injections.
The nurse is giving discharge instructions to a woman who will be taking amoxicillin for treatment of acute otitis media. The nurse teaches the client that which symptom indicates the development of a superinfection and should be reported to the physician?
Vaginal itching and discharge
A client diagnosed with acute uncomplicated cystitis has been prescribed ciprofloxacin 250 mg PO BID x 7 days. When teaching the client about this medication, what guidance would the nurse include? Select all that apply.
“Antacids can interfere with the absorption of this medication.”
“Try to avoid direct sunlight while you are taking this medication.”
A young adult client’s acne has responded well to treatment with tetracycline. However, the client has now returned to the clinic 6 weeks later with signs and symptoms of oral candidiasis. The nurse should recognize that this client’s current health problem is likely attributable to which occurrence?
Superinfection following the eradication of normal oral flora
A 25-year-old woman is being treated with penicillin G as prophylaxis to prevent bacterial endocarditis prior to a dental procedure. The nurse should question the client concerning her the use of:
oral contraceptives
In preparation for discharge, the nurse is teaching a client about the prescription for telithromycin. The nurse should instruct the client to contact a health care provider if the client experiences:
yellowing of the eyes or skin.
A 9-year-old client has been admitted to the pediatric unit after being diagnosed with pertussis. The pediatric nurse is processing the client’s admission orders and notes that IV demeclocycline has been prescribed. After beginning this treatment, the nurse should confirm the results of what laboratory test?
Blood urea nitrogen (BUN)
A client with a gram-negative bacterial infection has been prescribed a fluoroquinolone. During the preadministration assessment, the nurse should ensure that which laboratory tests, if prescribed, are obtained before the first dose of fluoroquinolones is administered to the client?
culture and sensitivity test
Tetracycline is often a viable treatment option when a client has an allergy to what antibiotics?
penicillins
The nurse is performing an assessment on a 7-year-old child in the clinic. The nurse observes the child’s teeth are darkly stained. What information should the nurse obtain from the parent?
Has the child taken tetracycline for treatment?
A client in the critical care unit is receiving aminoglycosides for an infectious process. What does the nurse need to monitor?
Renal function tests
The nurse is assisting in the admission of a client with a suspected urinary tract infection and an oral temperature of 100.9°F. The health care provider has written the following orders: acetaminophen 500 mg PO for elevated temperature; urinalysis for culture and sensitivity; sulfasalazine (Azulfidine) 500 mg PO four times daily; and force fluids to 3 L/day. Which order will the nurse complete first?
Obtain urine for culture and sensitivity.
A nurse is caring for a patient undergoing the second phase of standard TB treatment. The nurse knows that which of the following combinations of drugs need to be administered to the client?
Rifampin and isoniazid
The nurse is reviewing recent laboratory values for an older client prior to administration of tetracycline. Which finding would lead the nurse to hold the dose?
creatinine of 2.8 mg/dL (247.52 µmol/L) (high)
The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring?
Red man syndrome
Explanation:
The nurse must be careful to infuse vancomycin at the prescribed rate to prevent the occurrence of red man syndrome. With this syndrome, the client’s face and upper trunk becomes bright red, and it has led to cardiovascular collapse.
A nurse is conducting an in-service education program for a group of nurses. When describing the action of the various classes of penicillins, which class would the nurse identify as having the narrowest spectrum of activity?
natural penicillins
Explanation:
The natural penicillins have the narrowest spectrum of activity of all of the classes of penicillins. Extended-spectrum penicillins are even more effective than broad-spectrum penicillins used to destroy bacteria such as Pseudomonas. The penicillinase-resistant penicillins were developed to combat the bacteria that have developed a resistant enzyme. Aminopenicillins were chemically modified to combat more strains of bacteria than natural penicillins.
The health care provider is preparing to order rifampin and pyrazinamide for a female client with active tuberculosis. What question should the provider ask this client before confirming this order?
“Are you pregnant?”
Explanation:
Pyrazinamide and streptomycin are contraindicated in pregnancy. A regimen of INH, rifampin, and ethambutol is usually used in the treatment of pregnant women.
A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan?
Take the drug on an empty stomach.
Explanation:
Oral preparations of tetracycline should be administered on an empty stomach with a full glass of water to maximize absorption. Tetracycline is not absorbed effectively if taken with food, dairy products, or immediately after meals.
The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem?
methicillin-resistant Staphylococcus aureus (MRSA) infection
Explanation:
Ceftaroline is an IV cephalosporin for the treatment of community-acquired pneumonia and skin infections. It is the first cephalosporin to be considered active against resistant gram-positive organisms, such as MRSA. This drug is not indicated in the treatment of chlamydial infections, endocarditis, or encephalitis.
A client is diagnosed with an infection attributable to the gram-negative microorganism Pseudomonas. Which anti-infective agent is most reliable in treating this microorganism?
Aminoglycoside
Explanation:
Aminoglycosides penetrate the cell walls of susceptible bacteria. As a result, the bacterial cell membrane becomes defective and cannot synthesize the proteins necessary for their function and replication. Aminoglycosides are used to treat infections caused by gram-negative microorganisms, such as Pseudomonas. Antifungals are effective in the resolution of fungus infections. Aminopenicillin agents are not effective in treating gram-negative microorganisms. A GABA analog is used to treat pain related to neuropathy.
The nurse is caring for a 6-year-old child who has pyelonephritis. The use of what group of antibiotics would be contraindicated due to the client’s age?
Tetracyclines
Explanation:
Tetracyclines can potentially damage developing teeth and bones and thus should be used cautiously or avoided in children under the age of 8 years. Penicillins are safe to give to children and commonly used. Cephalosporins are safe to administer to pediatric clients. Aminoglycosides would not be administered to children lightly, but they can be administered when the benefits outweigh the risks, such as an infection that is resistant to other drugs.
A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client?
Nausea
Explanation:
The most common adverse reactions that are caused due to cephalosporin administration include nausea, vomiting, and diarrhea. Cephalosporin does not cause hypotension, chest pain, or excessive tearing; hypotension and chest pain are some of the adverse reactions of disulfiram.
The nurse understands that which is the highest priority when teaching about antitubercular medications?
Taking medications as prescribed
Explanation:
For medications to be effective, it is most important that the nurse reinforce to the client that medications should be taken as prescribed and there should be no missed doses. Eating a well balanced diet, keeping hydrated and monitoring sputum are not medication priorities.
Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection?
Nephrotoxicity
A client diagnosed with malaria has been prescribed treatment with sulfadiazine. The nurse should encourage the client to increase consumption of what dietary component?
fluids
Explanation:
When this medication is used, it is imperative that the client maintain a fluid intake that allows for an output of 1500 mL of urine in 24 hours. While the client should attempt to consume a healthy well-balanced diet, fluid intake is vitally important.
A client newly diagnosed with syphilis is allergic to penicillin. What medication should this client be prescribed?
tetracycline
The nurse is caring for a client diagnosed with Legionnaires disease. What medication would the nurse expect the health care provider to prescribe?
Erythromycin
Explanation:
Erythromycin is the prototype macrolide used to treat Legionnaires disease.
The nurse is preparing to administer linezolid to a client. What assessment question should the nurse ask the client before administering the drug?
“Are you taking any medications for depression right now?”
Explanation:
The FDA has issued a black box warning stating that linezolid should not be administered to clients who are currently taking selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, tricyclic antidepressants, or monoamine oxidase inhibitors. It is thought that linezolid inhibits the action of monoamine oxidase A, an enzyme responsible for breaking down serotonin in the brain. Thus, high levels of serotonin build up in the brain, causing toxicity. None of the other questions are relevant to the safe administration of linezolid.
