Module 11A CH9 Antibiotics Flashcards
Bacteriosta
tic
Those substances that
prevent the growth or
reproduction of bacteria
Bactericida l
• Those that kill bacteria
directly
GOAL OF ANTIBIOTIC THERAPY
Decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invade
SELECTING TREATMENT
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
Gram- positive
The cell wall retains a stain or resists
decolorization with alcohol
Gram- negative
The cell wall loses a stain or is decolorized by
alcohol
Aerobic
• Depend on oxygen for survival
Anaerobic
• Do not use oxygen
BACTERIA AND RESISTANCE TO ANTIBIOTICS
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
USE OF ANTIBIOTICS ACROSS THE LIFE SPAN:
CHILDREN
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
USE OF ANTIBIOTICS ACROSS THE LIFE SPAN
ADULTS
• 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
USE OF ANTIBIOTICS ACROSS THE LIFE SPAN:
OLDER ADULTS
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
AMINOGLYCOSIDES
Indications
• Treatment of serious
infections
AMINOGLYCOSIDES Actions
• Bactericida
AMINO-GLYCOSIDES
Common medications:
Gentamicin • -mycin • Neomycin • Streptomyci n • Tobramycin
AMINOGLYCOSIDES
Contraindications
Adverse Effects
Drug-Drug Interactions
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
AMINOGLYCOSIDES: THE NURSING PROCESS
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
CARBAPENEMS
Indications/ Actions • Treatment of serious infections caused by susceptible bacteria • Bactericidal
Common medicati ons “– penem” • Doripenem • Ertapenem • Imipenem- cilastatin • Meropenem • Meopenem- vaborbactam
CARBAPENEMS
Contraindications
Adverse Effects
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
CARBAPENEMS: THE NURSING PROCESS
• 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
CEPHALOSPORINS
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
CEPHALOSPORINS
• 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
CEPHALOSPORINS: THE NURSING PROCESS
• 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
FLUOROQUINOLONES
Indications • used to treat urinary tract, respiratory tract, and skin infections Actions bacteriostatic Common medicatio ns “- floxacin” • Ciprofloxa cin • Levofloxac in • Moxifloxaci n • Ofloxacin
FLUOROQUINOLONES
Contraindication
• 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
FLUOROQUINOLONES: THE NURSING
PROCESS
• 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
PENICILLINS AND PENICILLINASE-RESISTANT
ANTIBIOTICS
• 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”
PENICILLINS AND PENICILLINASE-RESISTANT
ANTIBIOTICS
• Allergies to penicillin or cephalosporins
• Renal diseaseContraindications
• Pregnancy and lactationCaution
• Most significant GI tractAdverse Effects
• Tetracyclines, aminoglycosides
Drug–Drug
Interactions
PENICILLINS AND PENICILLINASE-RESISTANT
ANTIBIOTICS: THE NURSING PROCESS
• 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
SULFONAMIDES
action and indication
Action • Bacteriostatic by inhibiting folic acid synthesis Indications • Treatment of infections caused by gram- negative and gram- positive bacteria
SULFONAMIDES medication list
Most common medications (“- sulfa”) • sulfadiazine • sulfasalazine • trimethoprim- sulfamethoxazole
SULFONAMIDES
Contraindicatio
ns
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
NURSING CONSIDERATIONS FOR PATIENTS
RECEIVING SULFONAMIDES
• 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
TETRACYCLINES
Indication and Most common
medications “-
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
TETRACYCLINES
Contraindicati
ons
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
TETRACYCLINES
Drug-Drug
Interactions
Penicillin G, oral contraceptiv e therapy Digoxin Drug-Food Interactions Administer on empty stomach
TETRACYCLINES: THE NURSING PROCESS
• 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
ANTIMYCOBACTERIALS
• 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
ANTIMYCOBACTERIAL
Contraindicati
ons
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
ANTIMYCOBACTERIALS: THE NURSING
PROCESS
• 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
OTHER ANTIBIOTICS
Lincosamides clindamycin, lincomycin Lipoglycopeptid es telavancin, dalbavancin, oritavancin, vancomycin Macrolides erythromycin, azithromycin, clarithromycin, fidaxomicin Oxazolidinones tedizolid, linezolid Monobactam aztreonam
OTHER ANTIBIOTICS: THE NURSING PROCESS
• 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
