objective 4.2 (1)

Question 1

are everywhere, both on external environment of our bodies and on the internal environment of our bodies

Answer 1

microorganisms

Question 2

prescription required
one of the most commonly prescribed meds
classified according to the type of pathogen they are attacking antibiotics, antifungals, antiparasitic and antivirals
A chemical that will help get rid of living microorganisms that are
pathogenic to the client

Answer 2

antimicrobial agents

Question 3

what are the principles of antiinfective therapy?

Answer 3

A person will require an anti-infective when a pathogen is present
Prior to prescribing, the physician will have to determine what microorganism or pathogen is present
Bacteria are a large domain of single-celled, prokaryotic micro-
organisms; come in a wide range of shapes and characteristics;
requires further testing to determine appropriate treatment
Fungi (or Fungus-singular) are a member of a large group of
eukaryotic organisms which include yeast and molds; live and
feed on other organisms
A Virus is a small infectious agent
that can replicate only inside the living cells of organisms
Parasites are organisms, protozoa or worms that live on or in another organism; lives off that
organism as well

Question 4

how is bacteria classified?

Answer 4

shape
grouping
o2 requirements
gram staining

Question 5

what are the shapes of bacteria?

Answer 5

coccus, bacillus, spirillum

Question 6

what are the groups of bacteria?

Answer 6

diplo, strept, staphyl

Question 7

what are the 02 requirements for bacteria?

Answer 7

aerobes, anaerobes

Question 8

When normal host defences are compromised, a person becomes susceptible to infection
Once the microorganisms enter the body, multiply and overwhelm the hosts defense
system, clinical infection is visible

Answer 8

bacterial infections

Question 9

what are the signs and symptoms of bacterial infections?

Answer 9

fever, chills, sweating, redness, pain, swelling, fatigue, increased
WBC, & formation of pus

Question 10

Infection acquired by a person who has not recently (past year) been hospitalized or had a medical
procedure

Answer 10

community-acquired infection

Question 11

• Infection a patient acquires during the course of receiving treatment for another condition in a
  health care facility (Occurs at least 48 hours after admission)
• One of top 10 causes of death in Canada
• Tend to be more difficult to treat & resistant to traditional therapies (MRSA, VRE)
• Most commonly acquired through direct contact (IV equipment, catheters, dialysis equipment, etc.)
• Over 70% are preventable
• Handwashing is most important activity
• Use of antiseptics (static) and disinfectants (cidal) may help reduce (table 43-1)

Answer 11

health care-associated infection

Question 12

Selection of an antibiotic that can best
kill microorganisms known to be the most common
causes of infection

Answer 12

emplrlc therapy

Question 13

AKA Targeted therapy. Antibiotic
therapy is tailored to treat the identified organism by
using the most narrow spectrum & least toxic drug
based on C&S results

Answer 13

definitive therapy

Question 14

Antibiotics used to prevent
infection (i.e. prior to surgery)

Answer 14

prophylactic therapy

Question 15

is an infection that follows a viral or fungal infection the weakened immune system

Answer 15

secondary infections

Question 16

Occurs in individuals with a viral or fungal infections and who also develop a bacterial
infection because of their weakened immune system

Answer 16

mixed infections

Question 16

Antibiotic kills normal bacteria(normal flora) and other organisms that are not sensitive to
a prescribed antibiotic are able to multiply, overgrow and get out of control. Ex. Vaginal
yeast infection or thrush , Clostridium difficile

Answer 16

superinfections

Question 17

Many organisms have become resistant to available antibiotics

Answer 17

super germs

Question 18

A sensitivity to one substance that predisposes an individual to sensitivity to other
substances

Answer 18

cross sensitivity

Question 19

antibiotics that kill the bacteria

Answer 19

bactericidal

Question 20

limit or slow the growth of the bacteria

Answer 20

bacteriostatic

Question 21

to therapy includes a decrease in S/S of infection compared to baseline findings

Answer 21

therapeutic response

Question 22

occurs when the S/S do not improve

Answer 22

subtherepeutic response

Question 23

can occur when bacteria reduce or eliminate normal bacteria that are needed to maintain
normal function. When these bacteria are absent, other opportunistic bacteria occupy and infect

Answer 23

superinfections

Question 24

what are general adverse effects of antibiotic therapy?

Answer 24

destruction of the bodys normal flora allergy ototoxicity, nephrotoxicity, hepatotoxicity GI distress

Question 25

what can overuse or unnecessary use of antibiotic therapy result in?

Answer 25

* Patients expecting a prescription every time they are ill (antibiotics are not effective on viral infections) * The weaker organisms being killed, leaving only the stronger and more resistant organisms * Exposing organisms to antibiotics that did not kill them has led them to become resistant or a “sugerbug” Ex: MRSA * Not finishing a course of antibiotics can also result in resistance

Question 26

what are the most common categories of antibiotics>

Answer 26

Sulfonamides, Penicllins, Cephalosporins, Carbapenems, Macrolides, Quinolones, Aminoglycosides, & Tetracyclines

Question 27

what are the 4 most common MOAs of antibiotic actions?

Answer 27

* Interference with bacterial cell wall synthesis * Interference with protein synthesis * Interference with replication of DNA * Antimetabolite action that disrupts critical reactions inside the bacterial cell

Question 28

original group is the1st generation, later groups is the 2nd generation, and so on.

Answer 28

generation

Question 29

one of the first groups of drugs used as antibiotics Many compounds, but only sulfamethoxazole combined with trimethoprim is commonly used

Answer 29

sulfonamides

Question 30

what are the MOAs of sulfonamides>

Answer 30

Bacteriostatic – inhibit bacterial growth by inhibiting folic acid synthesis needed for cell growth and function * Do not affect cells that require exogenous folic acid sources (human cells). Therefore, does not affect folic acid in people

Question 31

what are the indications of sulfonamides?

Answer 31

Broad spectrum. Used against both gram + & - bacteria, reaches high concentration in the kidney prior to elimination * Treat acute and chronic UTIs (cystitis, pylenophritis, ulcerative colitis, respiratory infections, prophylaxis bowel surgery, etc.

Question 32

what are the contraindications of sulfonamides?

Answer 32

* Known Allery * Pregnant women at term, * Infants younger than 2 months

Question 33

what are the interactions of sulfonamides?

Answer 33

* Potentiate the effects of: * Oral anticoagulants (warfarin) * Sulfonylureas (potentiate hypoglycemic effects) * Toxic effects with Dilantic

Question 34

what are the adverse effects of sulfonamides?

Answer 34

Headache Allergic reaction “Sulfa allergy” (delayed onset) Proteinuria- large amts of protein in urine Skin rash Dizziness/Vertigo Tinnitus, hearing loss Insomnia Anorexia, GI upset Stomatitis Crystalluria- formation of crystals in the Urine Photosensitivity (w/ exposure to sunlight)

Question 35

what are the nursing implications of sulfonamides?

Answer 35

* Sulfonamides should be taken with an empty stomach, 1hr before or 2hr after a meal, take with a full glass of water * Educate client about potential for bad sunburn due to increased photosensitivity * Increase fluid intake to prevent urine crystallizations * Intake and Output (excreted by kidneys)

Question 36

* Main antibiotic for years * Broad Spectrum Antibiotic of choice, considered to be the safest antibiotics, well tolerated * Derived from mold * Overuse * Penicillin-resistant strains * Can be oral or parenteral * Often end in ‘cillin’ but some do not especially trade names (ex. Clavulin). *important when it comes to allergies*

Answer 36

penicillin's

Question 37

what are the MOAs of penicillins

Answer 37

 Interferes with the creation and repair of the cell wall of bacteria.  causes weakening, which leads to cell walls bursting!!

Question 38

what are the interactions of penicillins?

Answer 38

* Treat multiple infections: most Gram positive bacteria, streptococcus, staphylococcus * Otitis media, pneumonia, STI’s, UTI’s * Prophylactic treatment against bacterial endocarditis in patients with rheumatic or congenital heart disease before dental procedures or upper respiratory tract surgery. * Natural pens not able to kill gram neg bacteria. Extended spectrum pens have great coverage of gram pos and neg (i.e. Piperacillin/tazobactam)

Question 39

what are the adverse effects of penicillin?

Answer 39

* Neuropathy (widespread nerve damage, seen with high parenteral doses) * Skin eruptions, urticaria (hives) * GI symptoms (N&V epigastric distress) * Allergies (Rashes, erythema, urticaria, angioedema, laryngeal edema & anaphylaxis (0.7 to 4%)) * Table 43-4 pg. 700

Question 40

what are the drug interactions of penicillins?

Answer 40

* Those with allergy to penicillin's may have a cross sensitivity to cephalosporin's * may  effectiveness of oral contraceptives * Antacids reduce absorption * Warfarin –enhanced anticoagulant effect * Table 43-5

Question 41

what are the nursing implications of penicillin?

Answer 41

* Assess for signs of worsening infection while on treatment * Cultures should be taken before starting antibiotic therapy * Assess and monitor for allergies, type of reaction * Educate client about the importance of finishing the medication as directed by physician * Best taken on empty stomach (except PenV *; amoxicillin) * Monitor cross sensitivity with other drugs (Cephalosporins) * Monitor for superinfections * Mouth care (opportunistic yeast infections)

Question 42

* Structurally and pharmacologically related to penicillins * Most have “ceph or kef” in their names

Answer 42

cephalosporins cefazolin, ceftriaxone

Question 43

what are the MOAs of cephalosporins?

Answer 43

Weaken bacteria by interfering with building bacteria’s cell wall; making them defective and unstable

Question 44

what are the indications of cephalosporins?

Answer 44

Weaken bacteria by interfering with building bacteria’s cell wall; making them defective and unstable

Question 45

Inhibits the growth of most gram positive cocci and a mild effect on some gram negative microbes * Ex: Keflex (cephalexin), Ancef (cefazolin)

Answer 45

first generation cephalosporins

Question 46

Has an improved ability to fight a greater number of gram negative microorganisms than the 1st generation; only generation to cover anaerobic microorganisms * Ex: mefoxin (ceftoxitin), Ceclor (cefaclor)

Answer 46

second generation cephalosporins

Question 47

More effective at inactivating beta-lactamase (an enzyme bacteria uses to build protection from antibiotics) * Ex: Rocephin (ceftriaxone), Claforan (ceftotaxime)

Answer 47

third generation cephalosporins

Question 48

Even broader spectrum and longer duration against bacterial enzymes produced to destroy penicillins. Used as adjunct to prolong the life and action of the penicillins; more effective at eliminating organisms that have built a resistance to earlier generations. * Ex: Maxipime (cefepime)

Answer 48

fourth generation cephalosporins

Question 49

Broad spectrum and covers gram-positive (including MRSA) and gram-negative organisms * Ex: ceftaroline fosamil

Answer 49

fifth generation cephalosporins

Question 50

what are the contraindications of cephalosporins?

Answer 50

Cross sensitivity with penicillin allergies

Question 51

what are the interactions of cephalosporins?

Answer 51

* Alcohol can cause flushing, tremors, dyspnea, increased HR and decreased BP (disulfiram reaction) * Increased risk of bleeding with anticoagulants * Probenecid may decrease excretion of drug * Oral Contraceptives less effective

Question 52

what are the nursing implications of cephalosporins?

Answer 52

* Monitor S/S of GI upset; give with food/milk * Monitor BM’s * Ensure labs are being monitored * Intake and Output * Rotate sites for administering * Ensure suspensions are refrigerated * Most cannot be given GI route as they are not absorbed

Question 53

what are the adverse effects of cephalosporins?

Answer 53

GI symptoms common- usually mild Superinfections esp in gut Nephrotoxicity Hypersensitivity- most common adverse effect Nephrotoxicity (esp older adults) Route complications

Question 54

Large group of antibiotics that first became available in the 1950s. Often considered a safe first choice with uncomplicated infections

Answer 54

macrolides

Question 55

what are the MAOs of macrolides?

Answer 55

Large group of antibiotics that first became available in the 1950s. Often considered a safe first choice with uncomplicated infections

Question 56

what are the indications of macrolids?

Answer 56

Alternative to penicillin allergies/resistance. * Used for Streptococcus bacteria, chlamydia, gonorrhea, Pertussis (whooping cough), skin infection, URTI, & c. diff * HP-pack for H.pylori

Question 57

what are the contraindications of macrolides?

Answer 57

* Known allergy * Many potential drug interactions. * Highly protein bound and metabolized in the liver, may compete with other medications for metabolization causing prolonged drug and potential toxic effects (i.e. warfarin, carbamazepine, etc.) * Reduce efficacy of oral contraceptives

Question 58

what are the nursing implications of macrolides?

Answer 58

* Newer Macrolide drugs have * Better GI tolerability * Broader spectrum of activity * Less dosing frequency * Hydrate well- extra fluids to dec. chances of renal toxicity * May be chewable tablet form, educate, must be fully chewed to obtain full effect * Taking medication with food decreases GI irritation. * Consistent administration

Question 59

what are the MAOs of tetracyclines?

Answer 59

Bacteriostatic agents, broad spectrum – interferes with the bacteria’s ability to make protein

Question 60

what are the indications of tetracyclines?

Answer 60

* Commonly used for treatment of Lyme disease, Helicobacter pylori (stomach ulcers),chlamydia * Also useful for prevention and treatment of acne * newest form is used for complicated infections, intra- abdominal infections and community-acquired pneumonia * Used as an alternative when patient has allergies to other abx.

Question 61

what are the contraindications of tetracyclines?

Answer 61

Known allergy, pregnancy, & children under 8, known liver disease

Question 62

what are the interactions of tetracyclines?

Answer 62

* Bind with calcium and iron to decreased absorption of tetracycline up to 50% * Antacids, antidiarrheal drugs, dairy products, calcium, enteral feeding & iron preparations * Can potentiate effects of oral anticoagulants

Question 63

what are the nursing implications of tetracyclines?

Answer 63

* Monitor out of date medications, can cause renal damage * Educate about potential interactions * Take with empty stomach * Avoid dairy * Drink plenty of water

Question 64

what are the adverse effects of tetracyclines?

Answer 64

* GI upset (mild N&V, diarrhea) * Superinfections- if long term use * Photosensitivity * Hepatotoxicity * The most serious but easily preventable are: * Inadequate bone or tooth development * permanent yellow/brown tooth discoloration * permanent skeletal damage to a fetus.