objective 4.2 (2)

Question 1

Majority of these medications are given via parenteral routes
These antibiotics can treat organisms that are resistant to one or more
classes of antimicrobial drugs (multidrug-resistant organisms)

Answer 1

intense antibiotics

Question 2

are one of the world’s top health problem. These include –
MRSA (Methicillin resistant staphylococcus aureus), VRE (Vancomycin-resistant enterococcus),
ESBL (Extended-spectrum B-lactamases), and KPC (Klebsilla pneumonia carbapenemase)

Answer 2

multidrug-resistance organisms

Question 3

• Have narrow therapeutic range; lowest and highest acceptable drug levels are not far apart
• Dosage is calculated based on the patient’s weight
• Blood levels will be monitored and dosage changes made accordingly (peak-trough)
• Can be used for eyes, skin, or ears but is best when given parenterally if needed for systemic
  infections; poor oral absorption
• Blood level monitoring very important in prescribing;
• Usually given in adjunct with other antibiotics (synergistic effect)
• Has a postantibiotic effect (PAE

Answer 3

aminoglycosides

Question 4

what are the actions of aminoglycosides?

Answer 4

• Bactericidal- Weakens bacteria
• Limit production of protein

Question 5

what are the uses of aminoglycosides?

Answer 5

• Used in treatment of serious aerobic gram negative infections (Those caused by E. Coli,
  Pseudomonas) and specific condition involving gram positive bacteria (S.Aureus and
  bacterial endocarditis)
• given preoperatively to sterilize bowel with colon surgery
• Used in treatment of TB
• Septicemias
• Also used as adjunct therapy because of synergistic effects and post antibiotic effects

Question 6

what are the interactions of aminoglycocides?

Answer 6

• Increases risk of nephrotoxicity if used with
  vancomycin
• Ototoxicity increases if used with aspirin,
  furosemide, and ethacrynic acid
• Vitamin K production can be reduced due to
  disturbances of the normal gut flora
• Can potentiate warfarin toxicity

Question 7

what are the nursing implications of aminoglycocides?

Answer 7

• Check for flank pain indicating renal
  involvement
• Monitor for tinnitus (ringing in the ears),
  vertigo (sensation of swinging or spinning
  when body is standing still),
• Weakness
• Blood levels should be closely watched
• Therapeutic drug monitoring, look at trough
  levels not the Peak levels if drug is given
  once a day
• Administer with caution in neonates because
  of immaturity of kidneys

Question 8

what are the adverse effects and contraindications of aminoglycosides?

Answer 8

• Nephrotoxic- they will attack and destroy renal tissue (damage/toxic to kidney)
• 5-25 % of people
• Urinary casts, proteinuria, inc. Blood Urea Nitrogen(BUN) and creatinine levels
• Ringing in the ears- Ototoxicity serious form of toxicity of this drug (damage of the ear
  by a toxin)
• Believed to be caused by damage to the 8th cranial nerve (vestibulocochlear
  nerve)
• Contraindications: Allergy, Pregnancy & lactation

Question 9

what are the MOAs for quinolones aka floroquinolones?

Answer 9

Potent bactericidal; act by interfering with bacterial DNA synthesis

Question 10

what are the indications of quinolones?

Answer 10

Effective against most gram – pathogens, and some gram +, broad
spectrum
* Most are excreted through the kidney unchanged, making them very effective in
treating complicated UTIs
* Used as alternatives to other antibiotics when treating resp, GI, gyne, skin, and
soft tissue infections, and STIs
* Very effective oral absorption as well

Question 11

what are the interactions of quinolones?

Answer 11

• Antacids, Calcium, magnesium, iron, zinc preparations ferrous sulphate reduce absorption
• Increase action of warfarin
• Avoid caffeine can increase anxiety and cause tachycardia

Question 12

what are the nursing implications?

Answer 12

• Take with food to avoid GI symptoms
• Avoid Coffee or caffeine containing products- can cause increase anxiety and cause tachycardia
• Avoid dairy products- reduce absorption
• Keep patient hydrated, to promote excretion
• Monitor ECG

Question 13

what are the adverse effects of quinolones?

Answer 13

CNS = dizziness, light headedness, insomnia
GI = GI upset (n, v, d, c ), thrush
INTEG = rash, flushing, pruritus, urticaria
EYES = Photosensitivity
Superinfections
Tendinitis and tendon rupture
tinnitus
Renal insufficiency
Joint pain
Neuropathy
ECG changes
More commonly with long time use

Question 14

One of the most powerful antibiotics

Answer 14

vancomycin

Question 15

what are the MOAs of vancomycin?

Answer 15

Bactericidal – inhibits the building of bacterial cell wall
* Use in caution with people with kidney function issues

Question 16

what are the interactions of vancomycin?

Answer 16

Can increase toxicity of other antibiotics, multiple drug and diluent
incompatibilities

Question 17

what are the indications of vancomycin?

Answer 17

Severe gram + infections (Staph Aureus & Pneumocystitis pneumonia);
MRSA.
* NOT active against gram -, fungi, or yeast

Question 18

what are the adverse effects of vancomycin?

Answer 18

• Frequent but minor
• flushing
• “red man syndrome”-flushing erythema or
  itching of the head, face, neck and upper
  trunk area (Commonly seen when drug is
  infused too rapidly)
• Hypotension, pain and muscle spasms in
  back & chest and dyspnea- if infused too
  rapidly
• Increased doses can cause nephrotoxicity
  and ototoxcity

Question 19

what are the nursing implications of vancomycin

Answer 19

• Given slowly (to reduce incidence of
  flushing and hypotension)
• Not absorbed very well in GI tract- given IV
• Monitor blood levels of drug, particularly
  trough levels
• Because it is excreted rapidly by the
  kidneys, monitor kidney functions
• Proper handwashing crucial!!!

Question 20

what is the nursing diagnosis process and antibiotics?

Answer 20

Assessment
* Allergies, history of illness, lab results, intake&output,
check for contraindications, medication history for
interactions, ethnocultural and developmental
variations, assess patient’s willingness to learn, C&S
reports
Diagnosis
* Ex: Inadequate knowledge r/t lack of information about
disease process and medication regime
Planning
* Set goals – patient will remain adherent to therapy
regimen for full duration of treatment – patient is free
of S/S of infection with negative C&S reports at end of
antibiotic therapy
Implementation: General nursing interventions that apply to antibiotics include the following:
* Give oral antibiotics within recommended time frames with fluids/foods as indicated
* All medication is to be taken as specifically order, in full and at appropriate time frames
* Doses are not to be omitted or doubled up
* Do not take oral antibiotics the same time as antacids, iron/calcium supplements, or laxatives
* NHP are only to be used if there are no known interactions
* Continuously monitor for hypersensitivity reactions
* If there are signs of a reaction, STOP drug immediately, contact HCP, and monitor
* Obtain C&S PRIOR to initiating first dose of abx if possible
Evaluation
* Monitor goals/outcomes, therapeutic & adverse effects
* Monitor patient S/S