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FINAL EXAM PHARM > Module 11A CH9 Antibiotics > Flashcards

Module 11A CH9 Antibiotics Flashcards

1
Q

Bacteriosta

tic

A

Those substances that
prevent the growth or
reproduction of bacteria

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2
Q

Bactericida l

A

• Those that kill bacteria

directly

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3
Q

GOAL OF ANTIBIOTIC THERAPY

A 
Decrease the
population of
the invading
bacteria to a
point where
the human
immune
system can
effectively
deal with the
invade
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4
Q

SELECTING TREATMENT

A

Identification of the causative organism
Based on the culture report, an antibiotic is chosen
that has been known to be effective at treating the
invading organism
CULTURE MUST BE COMPLETED BEFORE
ADMINISTRATION OF ANTIBIOTIC

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5
Q

Gram- positive

A

The cell wall retains a stain or resists

decolorization with alcohol

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6
Q

Gram- negative

A

The cell wall loses a stain or is decolorized by

alcohol

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7
Q

Aerobic

A

• Depend on oxygen for survival

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8
Q

Anaerobic

A

• Do not use oxygen

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9
Q

BACTERIA AND RESISTANCE TO ANTIBIOTICS

A 
Adapt to their
environment
The longer an
antibiotic has been
in use, the greater
the chance that the
bacteria will develop
into a resistant
strain
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10
Q

USE OF ANTIBIOTICS ACROSS THE LIFE SPAN:

CHILDREN

A

Kids are more sensitive to adverse effects
Super infections, especially oral candidiasis
Many do not have proven safety and efficacy
Some can cause harm to growing cartilage, bones, and teeth
Double check doses
Parent education

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11
Q

USE OF ANTIBIOTICS ACROSS THE LIFE SPAN

ADULTS

A 
• Only use as needed
• Take entire course
• Do not take antibiotics not prescribed to you
• Don’t save antibiotics for future use
Patient
education
• Only if benefits outweigh risks
• Adverse effects can affect fetus and neonates
• i.e. like tetracyclines can damage teeth and bones
Pregnancy
and lactation
• Oral contraceptives
Drug-Drug
interactions
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12
Q

USE OF ANTIBIOTICS ACROSS THE LIFE SPAN:

OLDER ADULTS

A 
Signs and symptoms of infections are different in the older adult
Patient education
• Only use as needed
• Take entire course
• Do not take antibiotics not prescribed to you
• Don’t save antibiotics for future use
More susceptible to adverse effects
• Monitor hydration
• Safety precautions
Renal and hepatic impairment
• Start low, go slow
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13
Q

AMINOGLYCOSIDES

Indications

A

• Treatment of serious

infections

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14
Q

AMINOGLYCOSIDES Actions

A

• Bactericida

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15
Q

AMINO-GLYCOSIDES

Common medications:

A 
Gentamicin
• -mycin
• Neomycin
• Streptomyci
n
• Tobramycin
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16
Q

AMINOGLYCOSIDES
Contraindications
Adverse Effects
Drug-Drug Interactions

A

Contraindications
• Known allergies, renal or hepatic disease, hearing loss, active herpes
or mycobacterial infection, myasthenia gravis or parkinsonism,
pregnancy & lactation

Adverse Effects
• Ototoxicity and nephrotoxicity are the most significant

Drug-Drug Interactions
• Penicillins, cephalosporins
• Diuretics, neuromuscular blockers, succinylcholine, or citrate
anticoagulated blood

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17
Q

AMINOGLYCOSIDES: THE NURSING PROCESS

A

Assessment
• History
• Allergy; renal or hepatic disease; preexisting hearing loss; active
infection with herpes, varicella, or fungal or mycobacterial
organisms; myasthenia gravis; parkinsonism
• Pregnancy or lactation
• Physical exam
• Orientation and reflexes
• Auditory testing
• Vital signs
• Lung sounds
• Perform culture and sensitivity tests at the site of infection
• Monitor appropriate lab results (WBC, renal function)

Nursing Diagnoses
• Acute pain
• Disturbed sensory perception (auditory)
• Risk for infection
• Excess fluid volume
• Deficient knowledge

Implementation
• Check culture and sensitivity reports
• Ensure that the patient receives a full course of aminoglycoside
as prescribed
• Monitor the infection site and presenting signs and symptoms
• Monitor the patient regularly for signs of nephrotoxicity,
neurotoxicity, and bone marrow suppression
• Provide safety measures to protect the patient if CNS effects
• Provide small, frequent meals as tolerated; frequent mouth
care; and ice chips or sugarless candy to suck if stomatitis and
sore mouth are problems
• Provide adequate fluids ensuring patient is hydrated at all times
during drug therapy

18
Q

CARBAPENEMS

A 
Indications/
Actions
• Treatment of
serious infections
caused by
susceptible
bacteria
• Bactericidal
Common
medicati
ons “–
penem”
• Doripenem
• Ertapenem
• Imipenem-
cilastatin
• Meropenem
• Meopenem-
vaborbactam
19
Q

CARBAPENEMS
Contraindications
Adverse Effects

A

Contraindications
• Known allergy to any of the carbapenms
or betalactams; seizure disorders,
meningitis, pregnancy and lactation

Adverse Effects
• Pseudomembranous colitis, Clostridium
difficile diarrhea, and nausea and
vomiting can lead to serious dehydration
and electrolyte imbalances, as well as
new serious infections/superinfections

Drug-drug
interactions
• Valproic acid
• Probenecid

20
Q

CARBAPENEMS: THE NURSING PROCESS

A

• Assessment
• History
• Allergy, Renal disease, Seizures, Pregnancy or
lactation, Inflammatory bowel disorders
• Physical
• Orientation and reflexes
• Vital signs
• Lung sounds
• Perform culture and sensitivity tests at the site of infection
• Monitor appropriate lab results
• Nursing Diagnoses
• Acute pain
• Risk for infection
• Deficient knowledge
Implementation
• Check culture and sensitivity reports
• Ensure that the patient receives the full course as prescribed
• Monitor the site of infection and presenting signs and
symptoms
• Monitor for signs of pseudomembranous colitis, severe
diarrhea, or superinfections
• Safety measures
• Provide small, frequent meals as tolerated
• Ensure that the patient is hydrated at all times during drug

21
Q

CEPHALOSPORINS

A 
Treatment of
infections
caused by
susceptible
bacteria
Indicati
ons

Action
• Bactericidal
• Bacteriostatic

Common medications – Prefix “cef”
First generation
cephalexin
Second
generation
cefaclor,
cefoxitin,
cefuroxime
Third generation
cefdinir,
cefotaxime,
cefpodoxime,
ceftriaxone
Fourth
generation
ceftolozane-
tazobactam
Fifth generation
ceftaroline
22
Q

CEPHALOSPORINS

A

• Allergies to cephalosporins or penicillin, hepatic
or renal impairmentContraindications

  • Unknown effects in pregnancy and lactationCaution
  • Most significant -GI tractAdverse Effects

Drug-Drug
Interactions
• Aminoglycosides, oral anticoagulants, ETOH

23
Q

CEPHALOSPORINS: THE NURSING PROCESS

A

• Assessment
• History: Allergy, Renal disease, Pregnancy or lactation
• Physical exam
• Assess for rash or lesions; examine injection sites for
abscess formation; respiratory status
• Perform culture and sensitivity tests at the site of infection
• Monitor appropriate labs
• Nursing Diagnoses
• Acute pain
• Risk for infection
• Deficient fluid volume and imbalanced nutrition: Less than body
requirements
• Deficient knowledge
• Implementation
•Check culture and sensitivity reports
•Monitor renal function test values before and periodically during therapy
•Ensure full course is taken as prescribed
•Monitor the infection site and presenting signs and symptoms
•Small, frequent meals as tolerated, frequent mouth care, ice chips or
sugarless candy
•Adequate fluids
•Monitor for any signs of superinfection
•Monitor and care for injection sites
•Safety measures
•Provide patient teaching
• Evaluation
•Patient response
•Effectiveness of teaching plan
•Effectiveness of comfort and safety measures
•Compliance with regimen

24
Q

FLUOROQUINOLONES

A 
Indications
• used to treat urinary
tract, respiratory tract,
and skin infections
Actions
 bacteriostatic
Common
medicatio
ns “-
floxacin”
• Ciprofloxa
cin
• Levofloxac
in
• Moxifloxaci
n
• Ofloxacin
25
Q

FLUOROQUINOLONES

Contraindication

A

• Known allergy, pregnancy and lactation, and renal dysfunction

Contraindication
ns
• Most common: CNS - headache, dizziness, insomnia, depression,
hallucinations
• Black box warning: risk for tendinitis and tendon rupture
Adverse
Effects
• Iron salts, sucralfate, mineral supplements, antacids
• Quinidine
• Theophylline
• NSAIDs
Drug-Drug
Interactions
26
Q

FLUOROQUINOLONES: THE NURSING

PROCESS

A

• Assessment
• History: Allergy; myasthenia gravis; renal disease;
pregnancy or lactation
• Physical exam
• Examine for rash or lesions; Orientation, affect, and
reflexes
• Perform culture and sensitivity tests at the site of
infection
• Monitor appropriate labs: renal function
• Nursing Diagnoses
• Acute pain
• Deficient fluid volume
• Imbalanced nutrition: Less than body requirements
• Deficient knowledge
• Implementation
• Check culture and sensitivity reports
• Monitor renal function tests before initiating therapy
• Ensure patient receives the full course as prescribed
• Monitor the site of infection and presenting signs and
symptoms
• Small, frequent meals as tolerated, mouth care, ice chips,
sugarless candy
• Safety measures
• Provide patient teaching
• Evaluation
• Patient response
• Effectiveness of teaching plan
• Effectiveness of comfort and safety measures
• Compliance with regimen

27
Q

PENICILLINS AND PENICILLINASE-RESISTANT

ANTIBIOTICS

A 
• Broad
spectrum
use
Indicati
ons
• Bactericid
al
Actions
• Penicillin G
benzathine
• Penicillin G
potassium
• Penicillin G
procaine
• Penicillin V
• Amoxicillin
• Ampicillin
Common
medicati
ons “-
icillin”
28
Q

PENICILLINS AND PENICILLINASE-RESISTANT

ANTIBIOTICS

A

• Allergies to penicillin or cephalosporins
• Renal diseaseContraindications
• Pregnancy and lactationCaution
• Most significant GI tractAdverse Effects
• Tetracyclines, aminoglycosides
Drug–Drug
Interactions

29
Q

PENICILLINS AND PENICILLINASE-RESISTANT

ANTIBIOTICS: THE NURSING PROCESS

A 
• Assessment
• History: Allergy; renal disease;
pregnancy or lactation
• Physical exam
• Examine skin and mucous membranes
for rashes or lesions
• Injection sites for abscess formation
• Respiratory status
• Abdominal assessment
• Monitor appropriate labs
• Nursing Diagnoses
• Acute pain
• Imbalanced nutrition: Less than body
requirements
• Deficient knowledge
• Implementation
• Check culture and sensitivity reports
• Monitor renal function tests before and periodically during therapy
• Ensure that the patient receives the full course as prescribed
• Monitor the site of infection and presenting signs and symptoms
• Small, frequent meals, frequent mouth care, offer ice chips or sugarless
candy, provide adequate fluids
• Monitor the patient for any signs of superinfection
• Monitor and care for injection sites
• Provide patient teaching
• Evaluation
• Patient response to drug
• Effectiveness of teaching plan, comfort and safety measures, and
compliance with regimen
30
Q

SULFONAMIDES

action and indication

A 
Action
• Bacteriostatic by
inhibiting folic acid
synthesis
Indications
• Treatment of infections
caused by gram-
negative and gram-
positive bacteria
31
Q

SULFONAMIDES medication list

A 
Most common
medications (“-
sulfa”)
• sulfadiazine
• sulfasalazine
• trimethoprim-
sulfamethoxazole
32
Q

SULFONAMIDES

Contraindicatio
ns

A

Contraindications
• Known allergy to any sulfonamide or thiazide
diuretics
• Pregnancy: Teratogenic

• GI symptoms
• Renal effects related to the filtration of the drugAdverse Effects
• tolbutamide, tolazamide, glyburide, glipizide, or
chlorpropamide
• Cyclosporine

Drug-Drug
Interactions

33
Q

NURSING CONSIDERATIONS FOR PATIENTS

RECEIVING SULFONAMIDES

A

• Assessment
• History: Allergy; renal disease; pregnancy or lactation
• Physical Exam
• Examine skin for rash or lesions; respiratory
status; orientation, affect, and reflexes;
abdominal status
• Obtain specimens for culture and sensitivity tests at
the site of infection
• Monitor appropriate labs: renal function and CBC
• Nursing Diagnoses
• Acute pain
• Disturbed sensory perception
• Imbalanced nutrition: Less than body requirements
• Deficient knowledge
• Implementation
• Check culture and sensitivity reports
• Monitor renal function tests before and periodically during therapy
• Ensure that the patient receives the full course as prescribed
• Take oral drug on empty stomach 1 hour before or 2 hours after meals with
full glass of water
• Discontinue immediately if hypersensitivity reactions occur
• Small, frequent meals and adequate fluids; frequent mouth care, ice chips or
sugarless candy
• Monitor CBC and urinalysis test results before and periodically during
therapy

34
Q

TETRACYCLINES
Indication and Most common
medications “-

A

Action
• Bacteriostatic

Indications
• Treatment of various
infections
• Substitute for PCN when it
is contraindicated
• Acne when penicillin is
contraindicated
Most common
medications “-
cycline”
• tetracycline
• doxycycline
• minocycline
35
Q

TETRACYCLINES
Contraindicati
ons

A 
Contraindicati
ons
Known
allergy to
tetracyclines
or to
tartrazine
Pregnancy
and lactation
Renal and
hepatic
dysfunction
Adverse
Effects
Most GI, but
possible
damage to
the teeth
and bones
36
Q

TETRACYCLINES
Drug-Drug
Interactions

A 
Penicillin G,
oral
contraceptiv
e therapy
Digoxin
Drug-Food
Interactions
Administer
on empty
stomach
37
Q

TETRACYCLINES: THE NURSING PROCESS

A

• Assessment
• History and physical exam
• Allergy; renal or hepatic disease; pregnancy or lactation
• Examine the skin for rash or lesions; respiratory status
• Perform culture and sensitivity tests at the site of infection
• Monitor appropriate labs: renal and hepatic function
• Nursing Diagnoses
• Diarrhea related to drug effects
• Imbalanced nutrition: Less than body requirements related
to GI effects, alteration in taste, and superinfections
• Impaired skin integrity related to rash and photosensitivity
• Deficient knowledge regarding drug therapy
• Implementation
• Check culture and sensitivity reports
• Monitor renal and liver function test results before and periodically
during therapy
• Ensure that the patient receives the full course as prescribed
• Take on empty stomach with a full 8-oz glass of water
• Discontinue the drug immediately if hypersensitivity reactions occur
• Small, frequent meals, frequent mouth care, ice chips or sugarless
candy
• Monitor for signs of superinfections
• Encourage the patient to apply sunscreen and wear clothing
• Provide patient teaching

38
Q

ANTIMYCOBACTERIALS

A 
• Bactericidal
• Act on the DNA of the bacteria
leading to lack of growth and
eventual bacterial death for TB
and Leprosy
Action
• Treatment of TB and Leprosy
Indicati
ons
Antituberculosis drugs
• Rifampin
• Pyrazinamide
• Ethambutol
• Streptomycin
• Isoniazid
Leprostatic drugs
• Dapsone
39
Q

ANTIMYCOBACTERIAL
Contraindicati
ons

A 
Allergy
Renal or
hepatic
failure
CNS
dysfunction
Pregnancy
and
lactation
Adverse
Effects
CNS effects
and GI
irritation
Drug-Drug
Interactions
Rifampin
and
isoniazid
can cause
liver toxicity
40
Q

ANTIMYCOBACTERIALS: THE NURSING

PROCESS

A

• Assessment
• History: Allergy; renal or hepatic disease; CNS dysfunction;
pregnancy
• Physical exam
• Examine the skin for rash or lesions; orientation, affect, and
reflexes; respiratory status
• Obtain specimens for culture and sensitivity testing
• Monitor appropriate labs: liver and renal function
• Nursing Diagnoses
• Imbalanced nutrition: Less than body requirements
• Disturbed sensory perception (kinesthetic)
• Acute pain
• Deficient knowledge
• Implementation
• Check culture and sensitivity reports
• Monitor renal and liver function test results before and
periodically during therapy
• Ensure that the patient receives the full course of the drugs
• Discontinue drug immediately if hypersensitivity reactions
occur
• Small, frequent meals, perform frequent mouth care, and drink
adequate fluids
• Provide patient teaching
• Evaluation
• Patient response to the drug
• Effectiveness of teaching plan
• Effectiveness of comfort and safety measures
• Compliance with regimen

41
Q

OTHER ANTIBIOTICS

A 
Lincosamides
clindamycin,
lincomycin
Lipoglycopeptid
es
telavancin,
dalbavancin,
oritavancin,
vancomycin
Macrolides
erythromycin,
azithromycin,
clarithromycin,
fidaxomicin
Oxazolidinones
tedizolid,
linezolid
Monobactam
aztreonam
42
Q

OTHER ANTIBIOTICS: THE NURSING PROCESS

A

• Assessment
• History: Allergy; renal or liver
disease; pregnancy or lactation
• Physical exam
• Examine the skin
• Orientation, affect, reflexes
• ECG
• Specimens for culture and
sensitivity testing from the site of
infection
• Monitor labs: renal and hepatic
function
• Nursing Diagnoses
• Acute pain
• Risk for infection
• Deficient knowledge
• Implementation
• Labs: culture & sensitivity, hepatic and renal function tests
• Complete course of antibiotics
• Swallow the tablet whole; it should not be cut, crushed, or chewed
• Monitor the site of infection and presenting signs and symptoms
• Small, frequent meals as tolerated; frequent mouth care and ice chips or sugarless candy
• Ensure ready access to bathroom facilities
• Institute safety measures
• Arrange for appropriate treatment of superinfections as needed
• For lincosamides: careful monitoring of GI activity and fluid balance
• For lipoglycopeptides: obtain a baseline QT interval on ECG; alert patient to possible foamy
urine; ensure patient is not pregnant or planning to be pregnant
• Provide patient teaching
• Evaluation
• Monitor the patient’s response
• Evaluate the effectiveness of the teaching plan, comfort measures, and safety measures
• Compliance with the regimen

FINAL EXAM PHARM (13 decks)

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