Pharm #6 Flashcards
Bacteria are classified by:
Shape and Ability of the cell wall to retain stain
Shape
Bacilli or Cocci
Bacilli-
elonged or rod shaped
Cocci-
spherical
Staphylococci-
clusters arrangement
Streptococci-
chains arrangement
Gram-positive-
cell wall is retaining the stain. Purple
Gram-negative-
cell wall does not retain stain- red
Single celled disease producing organisms classified by shape and staining to determine
type and how to treat
Antibacterials vs. Antibiotics/Antimicrobials
Used interchangeably
Antibacterial
inhibiting for killing bacteria
Antibiotics/Antimicrobials
can kill or inhibit the growth of bacteria and other microorganisms.
Bacteriostatic drugs
inhibit growth of bacteria
Bactericidal drugs
kill bacteria. The difference is the dose
Antibacterials/Antibiotics - How they are made.
Natural-penicillin vs. Synthetic- sulfonamides
Minimum effective concentration.
Therapeutic Index-
important for looking how a drug and antibacterial is effective in their system.
Therapeutic Index-
Peak best range to get the most effectiveness.
Therapeutic Index-
Minimum Effective Concentration (MEC ) to toxic level-
to not overload with the drug
Narrow therapeutic range- Peak and trough
closely monitor range in the blood by drawing peak and trough levels. More frequently drawn is troughs.
45mins-1hr after drug administered
Peak
drawn 15 mins before the dose is given
Trough
Before giving next dose, wait for the
trough level to come back
Antibacterial action
Inhibition of bacterial cell wall synthesis
Alteration of membrane permeability
Inhibition of protein synthesis
Inhibition of synthesis of bacterial RNA and DNA
Interference with metabolism within the cell- coping mechanisms to metabolise on its own
Inhibition of bacterial cell wall synthesis
- causing cell wall to break down which kills cell
Alteration of membrane permeability
alters physically there which causes cell lysis to occur. Damage property cell structure itself.
Inhibition of
protein synthesis
Inhibition of synthesis of
bacterial RNA and DNA
Interference with metabolism within the cell
coping mechanisms to metabolize on its own
Natural Body Defenses-
Age, Nutrition, Immunoglobulins, Circulation, WBCs, Organ function
Age-
Elderly and Infants are at risk for infection
Nutrition-
Malnourished unable to fight infection properly
Immunoglobulins-
antibodies-proteins made by immune system natural fighting off microorganisms.
Circulation-
decreased circulation effects healing process and the amount of antibacterial agents that can reach the area.
WBCs-
help fight infection
Organ function-
Contributing to the body’s natural response to fight infection. Tonsils, bone marrow, lymph nodes, Thymus/spleen helps
Resistance to antibacterials
Inherent resistance
Acquired resistance
Inherent resistance-
in genetic makeup
Acquired resistance-
overuse or not enough antibiotic use.
Caused by exposure to drug.
Classification AKA nosocomial infections
Health care acquired infections
Often due to drug resistant bacteria.
Health care acquired infections
Effected by HC acquired infections-
hospitalization-prolongs it.
Increase personal and HC facility healthcare facility cost.
The sensitivity of bacteria to a antibacterial can decrease causing
resistance
Culture and sensitivity test-
narrow spectrum for antibiotics to tx bacteria
Bacteria can evolve and develop to change the ways they
are killed by drugs
Antibiotic resistant bacteria-
MERSA methicillin resistant staphylococcus aureus
VREF- vancomycin resistance enterococcus faecium
Taking antibiotics unnecessarily
Antibiotic misuse
Taking antibiotics incorrectly
Antibiotic misuse
Increases antibiotic resistance
Antibiotic misuse
Can occur between antibacterial drugs with similar actions
Cross-resistance
PCNs and cephalosporins
Cross-resistance Example:
Doses should not be skipped and full course of antibiotics should be completed to help prevent
bacterial resistance
Used only for severe infections that are not responsive to single antibiotics.
antibiotic combinations
Additive effect- 2+2=4 creates perfect response
antibiotic combinations
Potentiate- 2+2=6, potentiates the effectiveness
antibiotic combinations
Antagonistic –
not a desired effect.
Combo that results in decreased effectiveness.
Ex: Penicillin and tetracycline.
Antibacterials: General Adverse Reactions
Allergic reaction, Superinfection, Organ toxicity
Allergic reaction- Mild to Severe
Rash
Pruritus-Itching
Hives
Allergic reaction Mild Tx:
antihistamine
Allergic reaction Severe Tx-
Anaphylactic shock give epinephrine or bronchodilator. Solumedrol to help with inflammatory
Superinfection-
occurs when normal bacterial flora are killed by antibacterial drugs
Secondary infection
Superinfection
Often fungal (Common) Vaginal candidiasis, thrush,- tx:niastatin
Superinfection
C. Diff- GI tract flora wiped out. Occurs with broad spectrum antibiotics
Superinfection
Organ toxicity
Ear- ototoxicity
Liver- Hepatotoxicity
Kidney- Nephrotoxicity
Narrow spectrum-
effective against one type of organism
Narrow spectrum-
effective against one type of organism
Primarily effective against one bacteria type (selective)
Narrow spectrum
Narrow spectrum Examples:
penicillin, erythromycin. Only effective on gram positive bacteria
Gives before getting results of culture and sensitivity back
Broad spectrum-
Effective against gram-positive and gram-negative (non-selective)
Broad spectrum-
Used before Culture & Sensitivity results are available
Broad spectrum-
Broad spectrum Examples:
tetracycline, cephalosporins
Structure of penicillins
Beta-lactam ring structure
Inhibit bacterial cell wall synthesis
Penicillins Action
Determines Bacteriostatic or bactericidal
Depending upon drug and dosage
Penicillins Action
Beta-lactamases (penicillinases)-
Enzymes that inactivate penicillin’s or other drugs with ring structure
Narrow-spectrum- use on gram positive bacteria.
Not Beta-lactamases (penicillinases)
Basic penicillins
Basic penicillins Effective against
gram-positive and a few gram-negative bacteria
Basic penicillins Treats
anthrax, tetanus, diphtheria, endocarditis, respiratory infections, syphilis
Penicillin-G
First developed
Penicillin VK
Basic
Broad-spectrum penicillins Effective
against gram-positive and gram-negative bacteria
Broad-spectrum penicillins Treats
respiratory, skin, intraabdominal, urinary tract, and gynecologic infections
Otitis media, sinusitis
Not penicillinase resistant
Broad-spectrum penicillins
Broad-spectrum penicillins Most common Examples:
amoxicillin & ampicillin
Penicillinase-resistant penicillins- tx
gram + bacteria
Penicillinase-resistant penicillins
Narrow-spectrum
Penicillinase-resistant penicillins effective against
gram-positive bacteria
Penicillinase-producing Staphylococcus aureus
Penicillinase-resistant penicillins use
Treats endocarditis, meningitis, bacteremia, skin, and respiratory infections
Penicillinase-resistant penicillins
Penicillinase-resistant penicillins Examples:
Dicloxacillin, nafcillin, & oxacillin
Extended-spectrum penicillins
Broad-spectrum
Extended-spectrum penicillins effective against
gram-negative bacteria that are difficult to eradicate
Extended-spectrum penicillins Treats
respiratory, intraabdominal, and skin infections
Extended-spectrum penicillins Example:
piperacillin, tazobactam
Beta-lactamase
breaks down penicillin inhibitors
Beta-lactamase Action
Inhibit bacterial beta-lactamases extending their antimicrobial spectrum
Beta-lactamase Not given alone
Combined with penicillinase-sensitive penicillin
Beta-lactamase Examples:
clavulanic acid, sulbactam & tazobactam
clavulanic acid-
penicillin combined with amoxicillin to get Augmentin
sulbactam-
penicillin with ampicillin to make unicin
tazobactam-
penicillin and piperacillin to make zocin
Given after penicillin alone is not
effective
Penicillins
Side effects/adverse reactions
Hypersensitivity, anaphylaxis
Superinfection- wiping out normal flora
Tongue discoloration, stomatitis
GI distress- educate with food to decrease GI distress
Clostridium difficile-associated diarrhea
Rash to anaphylactic shock
Occur in 5-10% of the population
Penicillins SE/dverse reacitons
Penicillins Severe side effects-
laryngeal edema- causes severe bronchoconstriction, stridor, and hypotension
Penicillins Assessment-
Allergic to pen or cephalosporins. Watch closely if giving ceph. Watch for liver enzyme labs. Urine output recording. monitoring antibacterial effectiveness of infection worsening. Culture and sensitivity.
Penicillins Nursing Interventions
Allergic reaction watching-having epinephrine available for anaphylaic shock
Penicillins-Education-
Not giving extended spectrum penicillin with an aminoglycoside bc it will inactivate the aminoglycoside.
Effect of amoxicillin will be decreased with acidic foods and juices.
Watching for bleeding- high doses of pen can caused decreased platelet aggregation.
Watch iv site- piggybacking it with something compatible with iv solution.
Take the whole coarse of antibiotics.
Report allergies-itching hives report to chart.
Encouraging fluids esp. with fever.
Females- on antibacterial needs back up form of contraception for oral contraceptives.
Cephalosporins structure
Beta-lactam
Cephalosporins Action
Inhibit bacterial cell-wall synthesis
Bactericidal
Cephalosporins Treats
Respiratory, urinary, skin, bone, joint, and genital infections
Cephalosporins Groups
First, second, third, fourth, and fifth generation.
Each generation becomes more effective for a broad spectrum antibiotic.
Increased resistance to beta-lactamases.
If get to the 5th generation= superinfection
Can be allergic to both
penicillins and cephalsporins
Starts with CEF generic names for __
Cephalosporins
Increased ability to cross BBB
Cephalosporins
Cephalosporins First-generation
Effective against mostly gram-positive and some gram-negative bacteria- staph and strep
Cephalosporins Second-generation
Effective against gram-positive and gram-negative bacteria
Effective against gram-positive and gram-negative bacteria
Cephalosporins Third-generation
Has increased resistance to destruction by beta-lactamases
Ceftriaxone (Rocephin)- prototype cephalosporin. Common in class
Cephalosporins Third-generation
Effective against gram-positive and gram-negative bacteria
Cephalosporins Fourth-generation
Highly resistant to beta lactamases
Cephalosporins Fourth-generation
Broad-spectrum
Cephalosporins Fourth-generation
Good CSF penetration
Cephalosporins Fourth-generation
Effective against gram-positive and gram-negative bacteria
Cephalosporins Fifth-generation
Broad-spectrum
Cephalosporins Fifth-generation
Highly resistant to beta lactamases
Cephalosporins Fifth-generation
Only cephalosporins effective against MRSA
Cephalosporins Fifth-generation
Cephalosporins Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection like c.diff
Headache, dysgeusia, GI distress
Increased bleeding, seizures
Nephrotoxicity
Elevated hepatic enzymes
Stevens-Johnson syndrome
Just bc allergic to penicillin- Does not mean they cannot get cephalosporins but
also puts a risk bc of similarity of structure
Increased risk of toxicity when taken loop diuretic
Cephalosporins
Monitor liver enzymes bc they can become elevated
Cephalosporins
Cephalosporins Drug interactions
Alcohol
Uricosurics
May cause disulfiram like reaction
Flushing, dizziness, headache, nausea, vomiting, and muscular cramps
Alcohol and Cephalosporins
Decrease cephalosporin excretion- toxicity. May need decreased dose
Uricosurics and Cephalosporins
Cephalosporins Assessment-
Liver and kidney labs. Allergies. Cultures to determine narrow spectrum.
Cephalosporins Nursing Interventions
IV infusing at least 30 mins to decrease irritation to the veins.
Cephalosporins Education
advise to increase yogurt/with good bacteria.
Follow coarse of instructions the whole time.
Take with food if GI upset which is common
Erythromycin
Macrolides
Inhibit protein synthesis
Macrolides: Erythromycin
Broad spectrum
Macrolides: Erythromycin
Effective against most gram-positive and some gram-negative bacteria
Macrolides: Erythromycin
Bacteriostatic with low to moderate doses
Macrolides: Erythromycin
Bactericidal with high doses
Macrolides: Erythromycin
Macrolides: Erythromycin Use
Mild to moderate respiratory, sinuses, skin, soft tissue, GI tract infections, diphtheria, impetigo, STIs
Macrolides examples
AZITHROMYCIN, CLARITHROMYCIN, & ERYTHROMYCIN
Best option if someone cannot take penicillin
AZITHROMYCIN
Not given IM bc it is painful
Macrolides: Erythromycin
Given orally and IV- administer slowly to decrease irritation to veins
Macrolides: Erythromycin
Macrolides: Erythromycin Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection
headache, seizures
Dysgeusia, tooth discoloration, GI distress
Clostridium difficile-associated diarrhea
Nephrotoxicity, hepatotoxicity- when combined with other drugs
Tinnitus/ototoxicity
Stevens-Johnson syndrome
hepatotoxicity is reversed once the drug is discontinued
Macrolides: Erythromycin
Increase serum levels of Warfarin(anticoagulant), theophylline(bronchodilator), and carbamazepine(epileptic drug)
Macrolides Drug interactions
Erythromycin & Fluconazole, ketoconazole, itraconazole, (antifungals) verapamil, diltiazem (CCBs)- increases levels of these drugs
Macrolides Drug interactions
Azithromycin & Antacids-decrease levels of these drugs
Macrolides Drug interactions
INR-Warfarin monitoring
Macrolides Drug interactions
Macrolides Assessment-
Watching liver and kidney labs.
Drug history.
Frequently taking antacids educate to take 2 hours before or after of administration of Azithromycin
Macrolides Nursing Interventions
extra caution to anyone with liver impairment (or disease)
Macrolides Education-
S/E reporting. S/Sx superinfection-diarrhea
Inhibit protein synthesis
Oxazolidinones Action
Effective against gram-positive bacteria
Oxazolidinones Action
Bacteriostatic and bactericidal
Dependent on dosage
Oxazolidinones Action
Oxazolidinones Use
Bacteremia, sepsis, MRSA, VREF
Respiratory and skin infections
Oxazolidinones Examples:
linezolid (Zyvox) & tidezolid
Oxazolidinones Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Tongue and tooth discoloration, GI distress
Peripheral neuropathy, headache, seizure
Anemia, thrombocytopenia, neutropenia
Clostridium difficile-associated diarrhea
Stevens-Johnson syndrome
Inhibit bacterial protein synthesis
Lincosamides Action
Effective against most gram-positive bacteria
Lincosamides Action
S. aureus and anaerobic organisms
Lincosamides Action
Bacteriostatic and bactericidal
Dependent on dosage
Lincosamides Action
Acne
Lincosamides Uses
Bacteremia, septicemia, MRSA,
Lincosamides Uses
Respiratory, intraabdominal, skin, gynecologic, and bone/joint infections
Lincosamides Uses
Lincosamides Examples:
clindamycin & lincomycin
Lincosamides Main – better absorbed in the GI tract
clindamycin
Lincosamides Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection
Xerosis, dysgeusia, glossitis, stomatitis, GI distress
Clostridium difficile-associated diarrhea
Pancytopenia
Stevens-Johnson syndrome
Lincosamides Drug Interactions
Incompatible with aminophylline, phenytoin, barbiturates, and ampicillin
Drug history before giving
Lincosamides
Any antibacterials risk for
superinfection
Glycopeptides Action
Inhibit cell wall synthesis
Bactericidal
Respiratory, skin, and bone/joint infections
Glycopeptides Use
Bacteremia, septicemia, and endocarditis
Glycopeptides Use
MRSA, and other infections that do not responds to or are resistant to other antibiotics Clostridium difficile-associated diarrhea
Glycopeptides Use
Tx- C-Diff
Glycopeptides
Glycopeptides Example:
Vancomycin(main glycol)
Glycopeptides Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection
Red neck or red man syndrome
Disulfiram
GI distress and peripheral edema
Ototoxicity
Nephrotoxicity
Stevens-Johnson syndrome
- when drug given too fast or infused at an improper rate. Via IV. Causing redness, blochness. Neck arms upperbody and back. Not considered allergic reaction
Red neck or red man syndrome
like reaction to alcohol
Disulfiram
– can result in permanent hearing loss
Ototoxicity
Dimenhydrinate- mask ototoxicity if taken with vancomyicin
Glycopeptides Drug Interactions
Furosemide, aminoglycosides, amphotericin B, colistin, cyclosporine- increase the effect of the nephrotoxicity and ototoxicity that vancomycin can cause
Glycopeptides Drug Interactions
Methotrexate(DMARDs)- vancomycin can inhibit the excretion of methotrexate. Can become very sick
Glycopeptides Drug Interactions
Cholestyramine, colestipol(lipid reducing agents)- decrease the absorption of oral vancomycin
Glycopeptides Drug Interactions
Ketolides Action
Blocks bacterial protein synthesis
Ketolides Use
Treats community-acquired pneumonia, MRSA
Effective against Streptococcus pneumoniae, Haemophilus influenzae
Ketolides Example:
telithromycin
Structure like a macrolide
Ketolides
Derived from erythromycin- synthetic bacterial pulled from another synthetic antibacterial
Ketolides
Ketolides Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Dizziness, headache, visual disturbances
GI distress, dysgeusia
Clostridium difficile-associated diarrhea
Hepatoxicity
Exacerbation of myasthenia gravis- get med history
Ketolides Drug Interactions- ALOT
Statins, Itraconazole, ketoconazole, benzos
Rifampin, phenytoin, carbamazepine, phenobarbital
Cisapride, pimozide
Digoxin, metoprolol, midazolam, ritonavir sirolimus, tacrolimus
Ergot alkaloid derivates- migrinol
Ketolides contraindications
High cholesterol, seizures, a-fib, HTN, migraines
Inhibit protein synthesis
Tetracyclines Action
Bacteriostatic effect-slows growth
Tetracyclines Action
Broad spectrum
Tetracyclines Action
Effective against gram-positive and gram-negative bacteria, such as Helicobacter pylori, MRSA
Tetracyclines Uses
Treats acne(low doses), anthrax, plague, gingivitis, cholera, STIs, skin, and urinary and respiratory infections
Tetracyclines Uses
Mainly given orally but can give IV
Tetracyclines Uses
Tetracyclines Examples:
tetracycline, minocycline & doxycycline
Tetracyclines prototype
doxycycline
Tetracyclines Combined with Metronidazole (antifungal) and bismufsalisate (pepto bismol) to treats ___ .
Treats acidity and bacteria
H pylori
Tetracyclines Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection
Photosensitivity, diplopia
Discoloration of permanent teeth
Stomatitis, glossitis, frequent GI distress
Clostridium difficile-associated diarrhea
Teratogenic
Ototoxicity, hepatotoxicity, nephrotoxicity
Pancytopenia, Stevens-Johnson syndrome
Avoid giving to pregnant women- teratogenic and children under the age of 8
Tetracyclines
Drugs and foods with calcium & iron- inhibit absorption of tetra
Specifically Antacids
Tetracyclines Drug–food interactions
Milk products inhibits absorption
Tetracyclines Drug–food interactions
Aminoglycosides- increase risk of nephron toxicity
Tetracyclines Drug–food interactions
Penicillin and Tetracyclines- decrease effectiveness of oral contraceptives’
Tetracyclines Drug–food interactions
lipid soluble drugs must be taken with milk or food
minocycline & doxycycline
Tetracyclines Assessment
Drug history, foods eaten, renal and liver funct.
Administer Tetracycline 1 hr before a meal or 2 hrs after a meal for best outcome of absorption.
Health history in female patients who can become or are pregnant to avoid giving to them.
Tetracyclines Nursing Interventions
Watching expiration dates- expired is toxic.
Kept away from light and extreme heat-causing decomposition of a drug.
Tetracyclines Education
Use sunscreen and protective clothing bc can cause photosensitivity.
Parents need to know under age of 8 should not take Tetracyclines
Educate female pts using back up contraceptives if on oral
Glycylcyclines Action
Block protein synthesis in bacterial cells
Bacteriostatic
Glycylcyclines Use
Complicated skin and intraabdominal infections, community-acquired pneumonia
Glycylcyclines Example:
tigeclycline
Synthetic antibacterial from tetracycline
Infections related to skin and GI used
Glycylcyclines
Glycylcyclines Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection
Photosensitivity, headache, dizziness, insomnia
GI distress, anemia
Hyperglycemia, hypokalemia
Clostridium difficile-associated diarrhea
Stevens-Johnson syndrome
Similar s/e with tetracyclines
Glycylcyclines
Aminoglycosides Action
Inhibit bacterial protein synthesis
Bactericidal- killing bacteria
Treats serious respiratory, skin, urinary, bone/joint, intraabdominal infections, plague, bacteremia, septicemia, endocarditis, meningitis, and hepatic encephalopathy
Aminoglycosides Use
Bowel preparation
Aminoglycosides Use
Therapeutic Range for Gentamicin (prototype) Peak levels =
5-8 mcg/mL (hr after administration)
Therapeutic Range for Gentamicin (prototype) Trough levels =
<1-2mcg/mL(15 mins before)
Aminoglycosides Examples:
Gentamicin & neomycin
Not well absorbed by gi tract- given IV or IM
Aminoglycosides
Aminoglycosides Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection, seizures
Photosensitivity, anemia, stomatitis, GI distress
Ototoxicity, nephrotoxicity, neurotoxicity-serious effects
Clostridium difficile–associated diarrhea
Stevens-Johnson syndrome
Penicillins- can decrease effectiveness of amino
Aminoglycosides Drug interactions
Warfarin- increase effect of warfarin (monitoring PT and INR)
Aminoglycosides Drug interactions
Cephalosporins, vancomycin, & diuretics- Can cause increase risk of ototoxicity
Aminoglycosides Drug interactions
Tinnitus and progressive hearing loss are warning signs of
ototoxicity
Aminoglycosides Assessment-
Watching urine output(nephrotoxic). Liver and kidney values, drug and health history
Aminoglycosides Education-
use protective clothing and sunscreen. Adequate fluid intake to flush kidneys out.
Interfere with enzyme DNA gyrase needed to synthesize bacterial DNA
Fluoroquinolones Action
Aminoglycosides Nursing Interventions-
monitor for hearing loss or possible symptoms of ototoxicity. Peak and trough for gentamycin.
Effective against gram-positive and gram-negative bacteria
Fluoroquinolones Action
Bactericidal- kill bacteria
Fluoroquinolones Action
Anthrax
Fluoroquinolones Use
Infections of the skin, soft tissue, bones, joints, and respiratory tract
Fluoroquinolones Use
Gynecologic, intraabdominal, urinary infections
Fluoroquinolones Use
Fluoroquinolones Examples:
ciprofloxacin (cipro) & levofloxacin (Levaquin)
Fluoroquinolones prototype
ciprofloxacin (cipro)
Fluoroquinolones - most commonly used
levofloxacin (Levaquin)
Fluoroquinolones Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection
Photosensitivity, eye damage, visual disturbances GI distress, dysgeusia
Peripheral neuropathy
Exacerbation of myasthenia gravis
Nephrotoxicity & hepatotoxicity
Tendinitis, tendon rupture
Clostridium difficile–associated diarrhea
Stevens-Johnson syndrome
Alters DNA
Fluoroquinolones
Used for pts that have no other options
Fluoroquinolones
Black box warning –peripheral neuropathy, exacerbation of MG, and tendon rupture
Fluoroquinolones
Antacids, Food, iron & calcium- decrease absorption of Fluoroquinolones
Fluoroquinolones Drug & Food Interactions
Oral antidiabetics(metformin, hypoglycemia risk), theophylline(increase bronchodilation), & caffeine(increase stimulation- increase effects
Fluoroquinolones Drug & Food Interactions
Severe gi distress- take with food but slows abruption down. Make take longer to treat
Fluoroquinolones
NSAIDs & steroids- increase levofloxacin (Levaquin) levels which increases risk of toxicity
Fluoroquinolones Drug & Food Interactions
Fluoroquinolones Nursing Interventions-
monitor lab results, vital signs esp. diabetic.
Give 2 hrs before or 2 hrs after antacid or iron for better absorption.
Have take with full glass of water.
Food will slow absorption down if gi distress problem. Theophylline levels- monitor serum levels,
watching for cns stimulation-nervousness, tachycardia
Fluoroquinolones Assessment-
Drug and health history. Diet history, liver kidney labs.
Fluoroquinolones Patient Education-
drink 6-8 classes of water each day to help properly excrete these drugs.
Avoid caffeine and heavy machinery until serum level steady
Sunglasses, sunblock protective clothing
Inhibit bacterial protein, DNA, and RNA synthesis
Lipopeptides Action
Effective against gram-positive Staphylococcus aureus, MRSA
Lipopeptides Action
Bactericidal
Lipopeptides Action
Lipopeptides Use
Treats complicated skin infections, septicemia, endocarditis
Lipopeptides Example:
daptomycin(common)
Lipopeptides Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection
Insomnia, dizziness
Anemia, bleeding
Chest pain, GI distress
Peripheral neuropathy
Hypo/hypertension hypo/hyperkalemia
Hypo/hyperglycemia
Rhabdomyolysis- muscle breakdown
Lipopeptides Drug interactions- decrease effective ness of these drugs
Statins
Tobramycin
Warfarin
Diabetics monitor them
Lipopeptides
Inhibit bacterial synthesis of folic acid which is necessary for gram negative bacteria to grow and reproduce.
Sulfonamides Action
Bacteriostatic
Effective against gram-negative bacteria
Sulfonamides Action
Sulfonamides Use
Treats otitis media, meningitis, malaria, and respiratory and urinary tract infections
Sulfonamides Example:
trimethoprim-sulfamethoxazole
Antifungal, Bactrim
Combo- synergistic effect for preventing bacterial resistance
trimethoprim-sulfamethoxazole (TMP-SMZ)
Drugs allergy
First antibacterial drugs developed
Sulfonamides
Oral antidiabetics- increase effects
Sulfonamides Drug interactions
Sulfonamides Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection- over use of drug
Photosensitivity
GI distress, stomatitis
Insomnia, tinnitus
Crystalluria, renal failure
Teratogenesis
Leukopenia, thrombocytopenia, anemia
Stevens-Johnson syndrome
Antacids- affect absorption
Sulfonamides Drug interactions
Warfarin- increases effects (risk for hypoglycemia
Sulfonamides Drug interactions
ACE inhibitors & spironolactone
Sulfonamides Drug interactions
Digoxin, phenytoin, & methotrexate- increase effectiveness = risk of toxicity
Sulfonamides Drug interactions
Need to know uti frequency
Sulfonamides
Increased potassium levels combined with ace inhibitors and spironolactone
Sulfonamides
Sulfonamides Assessment-
Drug and health history. Diet history, liver kidney labs.
Sulfonamides Nursing Interventions-
push fluids to prevent crystalluria, intake and output, s/sx of super infection
Sulfonamides Education-
drink 2L of fluid a day.
Pregnant pts avoid drugs.
Do not take with antacids
nitromidazoles Action
Disrupts DNA & protein synthesis in bacteria & protozoa
nitromidazoles Use
Clostridium difficile
H. pylori
Amebiasis, giardiasis, trichomoniasis, bacterial vaginitis
Acne
Meningitis
Intraabdominal & respiratory infections
nitromidazoles Example:
metronidazole (flagyl) & Tinidazole (tindamax)
Nitroimidazoles Side effects/adverse reactions
Hypersensitivity, Anaphylaxis
Superinfection
Headache, dizziness, insomnia, weakness
Dry mouth, dysgeusia, GI distress
Tongue/tooth discoloration
Peripheral neuropathy, seizures
Disulfiram-like reaction- when combined with alcohol- N/V
Stevens-Johnson syndrome
Nitroimidazoles Drug Interactions
Milk thistle- decrease abruption of the nitro
Which nursing intervention has the highest priority for the patient who is taking ceftriaxone?
Monitor the patient for signs and symptoms of a superinfection.
A patient is taking piperacillin–tazobactam. Which nursing interventions are most appropriate for this drug? (Select all that apply.)
Send specimen to lab for C&S before antibiotic therapy is started.
Instruct patient to take entire prescribed drug.
Monitor for symptoms of superinfection, including stomatitis and vaginitis.
Remember Piperacillin-tazobactam is a penicillin with a beta lactamase inhibitor
Injecting illegal drugs- Insafe practices of drug use
Tuberculosis Patients at risk
A patient enters the emergency department with a draining wound. Once the patient is admitted and assessed, the priority nursing intervention is to
culture the wound.
Health care workers who take care of high-risk patients in any setting- not knowing who has infections-patients
Tuberculosis Patients at risk
Which statement will the nurse include when teaching a patient about cephalosporin therapy?
“Inform your health care provider if you develop mouth ulcers.”
Relates to stomatitis
A patient asks the nurse why she gets yeast infections after a course of antibiotics. The nurse explains,
“Yeast infections are common when the normal body flora are disrupted.”
normal reaction for elimination/disruption of normal body flora
A patient is receiving gentamicin therapy: 100 mg intravenously at 0800, 1600, and 2400. At 0730, the nurse is informed that peak and trough levels need to be drawn. When is the best time to obtain the peak level?
0900 approximately an hour after administration
Which statement by a patient who has received teaching on tetracycline therapy indicates that more teaching is needed?
“I will take this medication with an antacid.”
antacid will decrease effectiveness
A patient is admitted to the health care facility with methicillin-resistant Staphylococcus aureus (MRSA). The nurse anticipates administration of which drug?
Vancomycin
Which antibacterial drug has the potential to cause adverse reactions of tendinitis, tendon rupture, and peripheral neuropathy?
Fluoroquinolones
many extreme adverse effects
When teaching a patient about trimethoprim-sulfamethoxazole (TMP-SMZ), the nurse gives highest priority to teaching the patient to
Increase fluid intake.
ototoxicity is not common side effects in this drug, we want to increase fluids for excretion
Tuberculosis Etiology
Mycobacterium tuberculosis
Acid-fast bacillus
Tuberculosis Transmission
Person to person via droplets
Coughing, sneezing, talking
Immunocompromised- can have active infection of TB if infected
Tuberculosis Patients at risk
Living or working in high-risk residential settings-Crowded living conditions
Tuberculosis Patients at risk
acid fast bacillus is positive in someone with
tuberculosis
Test done from someone’s sputum for a staining process. Looking at bacteria cell wall
Gram Stain
Droplet precautions
Tuberculosis
If good immune system- can still inhale droplets but the infection would be latent, can test positive but it is in a dormant stage. But if they got sick it would become active
Tuberculosis
Exposed to TB (active) will have positive skin test and chest xray
Tuberculosis
Interferon Gamma Release Assay (IGRA)-
definitive blood test (gold standard)for tuberculosis- last option. Not done routinely
If had an exposure they need a skin test immediately.
Tuberculosis
After 8-10 weeks of exposure the test should be repeated esp. if the first test is negative. Chest xray done if skin test is positive.
Tuberculosis
Immigrants get TB vaccine- Bacillus Calmette-Guerin (BCG). Automatically will have a positive tb test. Skip the test and go straight to the chest xray
Tuberculosis
Tuberculosis Symptoms
Cough
Fever
Night sweats
Anorexia
Weight loss
Chest pain
Positive acid-fast bacilli in the sputum or bloody sputum- in sputum culture of smear
Prophylaxis for Tuberculosis
Isoniazid (INH)
Prophylaxis recommended for:
Individuals with > 5 mm skin test
Individuals with > 10 mm skin test
HIV positive
Anyone with recent exposure to active TB
Organ transplant recipients
Anyone immunocompromised
Individuals with > 5 mm skin test
Recent immigrants
Injection drug users
Residents and employees of high-risk settings
Mycobacterium lab personnel
Children under 4 or children/adolescents exposed to high-risk individuals
Individuals with > 10 mm skin test
Most commonly used drug to prevent infection
Isoniazid (INH)
Antitubercular drugs First line drugs
Isoniazid, rifampin, rifabutin, rifapentine, pyrazinamide, ethambutol
Antitubercular drug prototype
Isoniazid
Least toxic antitubercular drug
Ethambutol
Antitubercular drugs Second line drugs-
Aminosalicylate sodium
Capreomycin
Cycloserine
ethionamide
Streptomycin sulfate
used with first line drugs if the bacteria is drug resistant
Second line drugs
Antitubercular Drug Therapy Combination therapy phases
Phase 1 and 2
Phase 1- Duration:
2 months- combinations of 4 different types of antituberculars
Phase 2 - Duration:
4-7 months- 2 drugs taken. Not always definitive
More often a single drug is not going to be effective against __
Tuberculosis
Combination drug therapy when treating TB due to
drug resistance
Antitubercular Drug Side Effects
Hepatotoxicity
Ototoxicity
Headaches
GI distress
Photosensitivity
Paresthesias
Hyperglycemia
Hypocalcemia
Blood dyscrasias
Antitubercular Drugs- we want to prevent organ failure. Monitor LFTs.
Hepatotoxicity
Isoniazid-
prophylactic drug.
First line Tx: blocks vitamin B which causes Peripheral neuropathy – give with Pyridoxine (vitamin B6)
Isoniazid
Rifampin- educate pts
Turns body fluids orange (tears)
GI distress common
Ethambutol- first line drug
Ocular toxicity
Streptomycin- second line drug which causes
Nephrotoxicity- monitor kidney labs
Tuberculosis in Pregnancy-
If they have TB, the benefit will outweigh the risk because TB will be transferred to the fetus
Tuberculosis in HIV-
High risk for developing TB. Leading causes of death in HIV population.
Tuberculosis in Pediatrics-
Children are more likely to become sicker quicker with TB.
If child in latent phase in tb they still need to be treated
TB drugs are extremely expensive. Assess socioeconomic status and history when looking at who may need these drugs and access to HC.
Antitubercular Drugs Assessment-
If person is transient person or living in that area long term which causes multiple follow up appointments.
Antitubercular Drugs Assessment-
Asses health and drug history.
Antitubercular Drugs Assessment-
Liver panel, renal, and CBC.
Antitubercular Drugs Assessment-
S/Sx of peripheral neuropathy-make sure taking B6.
Antitubercular Drugs Assessment-
Obtaining baseline ear and eye exam/renal function
Antitubercular Drugs Assessment-
Social services if financial concern to make sure they have adequate resources to get help.
Antitubercular Drugs Nursing Interventions-
Assisting follow up appointments making sure they understand the importance of it.
Antitubercular Drugs Nursing Interventions-
Importance about the future, following up to provider
Antitubercular Drugs Nursing Interventions-
1 hr before or 2 hrs after a meal to help increased absorption rate- Isoniazid.
Antitubercular Drugs Nursing Interventions-
Take vitamin B6-pyridoxine.
Antitubercular Drugs Nursing Interventions-
When in hospital collecting sputum samples early in the morning to continually doing the acid fast bacillus test done 3 consecutive mornings- are the drugs effective or changing the cell wall
Antitubercular Drugs Nursing Interventions-
educate importance to adherencing to drug regimend.
Antitubercular Drugs Education-
Providing education in spoken and written language.
Antitubercular Drugs Education-
Anyone else in family/household/work env needs to be tested for TB.
Antitubercular Drugs Education-
Proper hygiene- disposing tissues, wash hands- sputum on them.
Antitubercular Drugs Education-
Use separate dishes to elimatie cross contamination.
Antitubercular Drugs Education-
Do not take antacids when taking TB drugs.
Antitubercular Drugs Education-
Educate change in color in bodily fluids if taking rifampin its normal.
Antitubercular Drugs Education-
What S/Sx are in peripheral neuopathy and report immedtaely.
Antitubercular Drugs Education-
Can cause photosensitivity- sunscreen. Covering skin in the sun
Antitubercular Drugs Education-
Fungal Infections
Candidiasis, mycosis, tinea
Fungal Infections can be
Local or systemic
Mild and involves integumentary system
Local infections
Mucous membranes, hair, nails, and moist skin areas
Local infections
Local infections Examples:
Oral candidiasis (thrush), vaginal candidiasis, onychomycosis(nail fungus)
Severe
Systemic infections
Affects lungs, abdomen, central nervous system
Systemic infections
Systemic infections Examples:
fungal lung infection, fungal meningitis
Classification of Fungal Infections
Opportunistic and Primary infections
Usually occur in the immunocompromised or debilitated immune system population.
Opportunistic infections
Over growth of fungus from bodies weakened immune system
Opportunistic infections
Opportunistic infections Examples:
Candidiasis, aspergillosis, mucormycosis, pneumocystis pneumonia
Usually occur in immunocompetent(stronger immune system)
Primary infections
Acquired from inhaled spores
Primary infections
Primary infections Examples:
Blastomycosis, histoplasmosis, coccidioidomycosis, cryptococcosis, and paracoccidioidomycosis
Mycosis-
fungal infection
Antifungal Drug Groups
Polyenes
Azoles
Antimetabolic
Echinocandins
Polyenes
Amphotericin B, Nystatin (Mycostatin)
Amphotericin B- drug of choice
Polyenes
Amphotericin B Route
Only IV bc not well absorbed in GI tract.
Amphotericin B reactions are common-
fever, chills, SOB, tachypnea.
Occurs 1-3 hours from the beginning of the infusion.
Amphotericin B upside- pretreat to decrease the symptoms-
give acetaminophen, diphenhydramine, and hydrocortisone about 30-60mins before the infusion.
Amphotericin B Uses
Severe, systemic fungal infections bc nephrotoxicity Is high(monitor Kidney levels. Do not give if renal function bad)
Amphotericin B Action
Binds to fungal cell membranes, causing cell permeability, and leakage of cellular contents
Amphotericin B Side effects/adverse effects
Flushing, fever, chills, headache, dizziness
Tachypnea, shortness of breath, hypotension, GI distress
Paresthesia, thrombophlebitis, nephrotoxicity
Amphotericin B High doses cause
hypokalemia, hypomagnesemia
Infusion reactions are common
Not well absorbed in GI tract
Nystatin (Mycostatin)
Nystatin (Mycostatin)
Polyenes
Nystatin (Mycostatin) route
Oral (liquid swish & swallow), topical (powder or cream to decrease moisture)
Nystatin (Mycostatin) Action
Binds to sterols causing loss of intracellular potassium & cell contents
Nystatin (Mycostatin) Side effects/adverse effects
GI distress
Hyperglycemia, tachycardia
Angioedema, bronchospasm
Stevens-Johnson syndrome
Azoles
Fluconazole, Ketoconazole, & Metronidazole
Main two examples of azoles
Fluconazole, Ketoconazole
Fluconazole, Ketoconazole, & Metronidazole Route
Oral, IV, vaginal, topical
Fluconazole, Ketoconazole, & Metronidazole Action
Increases cell permeability and leakage by interfering with ergosterol formation
Fluconazole, Ketoconazole, & Metronidazole Side effects/effects
Headache, rash
GI distress
Hypokalemia, dysrhythmias, hepatotoxicity, nephrotoxicity
Lower toxicity than Amphotericin B
Fluconazole drug interactions
Warfarin increases prothrombin time when taking Fluconazole , Sulfonylureas causes increase effect (monitor BGL)
Antifungal drugs that are well absorbed in GI tract.
Azoles
Broad spectrum antibiotic for groups of fungal infections needed treated
Azoles
Antimetabolites
Flucytosine
Flucytosine Route
Oral
Selectively penetrates the fungal cell which disrupts fungal DNA and RNA synthesis
Flucytosine Action
Used in combination with other antifungals such as amphotericin
Flucytosine Action
Flucytosine Side effects/adverse effects
Renal and hepatic impairment (causes toxicity). Avoid renal and hepatic problem pts
In combination with Amphotericin B- treating severe fungal infection
Flucytosine
Echinocandins
Caspofungin & micafungin
Caspofungin & micafungin Route
IV-bc of lack of GI absorption
Caspofungin & micafungin Action
Inhibits biosynthesis of essential components of fungal cell wall which interferes with growth and reproduction
Caspofungin & micafungin Side effects/adverse effects
Injection site reaction
Elevated hepatic enzymes
Histamine-mediated reactions
Candidiasis and aspergillus infections used
Caspofungin & micafungin (Echinocandins)
Antifungals Assessment-
If they have oral thrush (candidiasis)- assess swallowing mechanism.
Monitor liver and kidney labs
Antifungals Nursing Interventions-
Obtain culture of the fungus to appropriately treat it.
Monitor urine output.
Side effects
Take all med as prescribes to get rid of infection.
Antifungals Education-
Advise to avoid alcohol bc it is already hepatotoxic drugs.
Antifungals Education-
Causes sleepiness and dizziness-avoid heavy machinery or driving until they know how their body reacts
Antifungals Education-
Survival & replication
Viruses
Viruses Methods of transmission
Droplets
Surfaces
Blood & body fluids
Common viral infections
Influenza, herpes, hepatitis.
Microorganism that are not able to live or reproduce on their own- need a host
Viruses
Invade host cell and live there and uses the hosts DNA to replicate itself.
Viruses
Difficult to destory the viral cell without destroying host cell
Viruses
Short life time on a surface.
Viruses
Highly contagious and infection viral respiratory infection
Influenza
Droplets enter respiratory tract
Influenza
Seasonal, more prevalent from fall to spring
Influenza
Influenza Antigen types
A, B, C
Influenza A
Can cause severe illness
Influenza B
Can cause severe illness
Usually causes mild illness in children
Influenza C
Usually causes mild illness
Not related to stomach flu
Influenza
Seasonal- see fall to spring
Influenza
Influenza Signs and symptoms
High fever, headache
Fatigue, weakness, myalgia
Watery nasal discharge
Red watery eyes
Chills, sore throat, nonproductive cough
Photophobia- sensitivity to light but not as common- seen with severe headache
aches
Influenza ___
Cold is a longer process
Abrupt onset
Herpes Viruses
Herpes simplex virus type 1 (HSV-1)
Herpes simplex virus type 2 (HSV-2)
Varicella-zoster viruses (HSV-3/VZV)
Epstein-Barr virus (HHV-4 or EBV)
Cytomegalovirus (HHV-5 or CMV)
Herpes simplex virus type 1 (HSV-1)
Causes cold sores on the mouth
Herpes simplex virus type 2 (HSV-2)
Causes lesions on genitalia
Varicella-zoster viruses (HSV-3/VZV)
Causes chickenpox and shingles
(reactivating due to weak immune system, localized to one part of the body, if getting again going to come back in the same area. Pruritic painful rash. Causes fever malase and myalsia. tale𝑙𝑡𝑎𝑖𝑙 𝑠𝑖𝑔𝑛 nerve pain). After initial infection the virus lays dormant in the nerves. Avoid children under age of 1.
shingles
Pruritic vesicles all over body and fever.
Transmitted with vesicles and lesions, precursor to shingles
chickenpox
Reactivating due to weak immune system, localized to one part of the body, if getting again going to come back in the same area. Pruritic painful rash.
shingles
Causes fever malaise and myalgia. Telltale sign-nerve pain.
After initial infection the virus lays dormant in the nerves.
Avoid children under age of 1.
shingles
Epstein-Barr virus (HHV-4 or EBV)
Causes mononucleosis spread by saliva exchange.
Fever, tonsillitis, extremely enlarged lymph nodes in the neck. Not identified right away.
Cytomegalovirus (HHV-5 or CMV) S/Sx:
Causes lymphadenopathy, splenomegaly, retinitis, & pneumonia(becomes fatal).
Effects immunocompromised. Spread through bodily fluids
Viral infection- transmitted with lesions or bodily fluids
Herpes Viruses
Hepatitis virus
Serious liver infection
Can infected either area- HSV 1 and HSV2- lesions or secretion contact
Herpes Viruses
Hepatitis A
Spreads via oral-fecal route.
Hepatitis B & C
Spread via blood and body fluids
Hepatitis virus Signs and symptoms (common)
Fatigue, malaise
Nausea, abdominal pain
Jaundice (bilirubin-yellow)
Liver impairment
Hepatitis virus
Non-HIV antivirals
Non-HIV antivirals
Non-HIV antivirals Action
Inhibits viral replication
Non-HIV Antivirals Types
Influenzas A and B
Herpes viruses
Hepatitis B & C
Cytomegalovirus
Influenza Antivirals
Oseltamivir (Tamiflu) &
Zanamivir (Relenza)
Main Influenza Antivirals
Oseltamivir (Tamiflu)
Influenza Antivirals Use
Influenza Type A & B
Decrease viral spread
Influenza Antivirals Action
Neuraminidase inhibitors- inhibit process of viral replication.
Influenza Antivirals Action
Shorten duration of signs and symptoms
Influenza Antivirals Action
Must be started within 48 hrs of onset of symptoms to be effective
Influenza Antivirals
Herpes Antivirals
Acyclovir, famciclovir & valacyclovir
Influenza Antivirals Side effects/adverse effects
Dizziness, headache
Insomnia, fatigue
GI distress (huge in Tamiflu)
Delirium
Herpes Antivirals most common
Acyclovir
Herpes Antivirals Use
Initial and recurrent episodes of oral & genital herpes
Chicken pox & shingles
Herpes Antivirals Side effects/adverse effects
N/V/D, orthostatic hypotension
HA, tremors, agitation
Lethargy, rash, itching, vein irritation
Increased bleeding time, anemia, blood dyscrasias
Crystalluria, neuropathy, seizures, nephrotoxicity(large doses)
Herpes Antivirals Action
Purine nucleoside antivirals
Interfere with DNA synthesis
Used during pregnancy to prevent outbreak during delivery
Decreases likely hood passing genital herpes infection to baby
Acyclovir, famciclovir & valacyclovir (Herpes antivirals)
Cytomegalovirus Antivirals
Ganciclovir, valganciclovir, cidofovir, & foscarnet.
Cytomegalovirus Antivirals Use
CMV retinitis in people with AIDS
Cytomegalovirus Antivirals Action
Inhibits DNA polymerase to suppress viral replication
Cytomegalovirus Antivirals Side effects/adverse effects
N/V/D, orthostatic hypotension
HA, tremors, agitation
Lethargy, rash, itching, vein irritation
Increased bleeding time, anemia, blood dyscrasias
Crystalluria, neuropathy, seizures, nephrotoxicity(large doses)
Hepatitis Antivirals
Adefovir, Entecavir, Daclatasvir & Ribavirin
Adefovir and Entecavir Use
Chronic Hep B and signs of liver disease
Daclatasvir & Ribavirin Use
Tx Hep C, inhibits viral replication
Adefovir, Entecavir, Daclatasvir & Ribavirin Use
Delays progression of liver disease caused by the hepatitis virus.
Adefovir, Entecavir, Daclatasvir & Ribavirin Action
Inhibit viral replication
Adefovir, Entecavir, Daclatasvir & Ribavirin- Side effects/adverse effects
Fatigue, flu-like symptoms, depression, alopecia
Photosensitivity, anorexia, dysgeusia, arthralgia, myalgia
Thyroid and ophthalmic dysfunction
Hepatotoxicity, renal impairment
Lactic acidosis, pancytopenia
Prototype drug.
Antivirals Acyclovir Assessment-
Baseline- renal or hepatic disease.
Antivirals Acyclovir Assessment-
Liver and kidney panels.
Antivirals Acyclovir Assessment-
CBC.
Monitor vital signs and labs.
Antivirals Acyclovir Assessment-
Give drugs with food to minimize GI distress.
Antivirals Acyclovir Assessment-
Decreased absorption with food.
Antivirals Acyclovir Assessment-
If IV dilute them.
Antivirals Acyclovir Nursing Interventions-
Increase fluids to promote kidney function.
Antivirals Acyclovir Nursing Interventions-
Antivirals Acyclovir Education-
dependent on what their viral circumstance is, how to prevent it from spreading.
Report S/sx of side effects.
Orthostatic hypotension risk
A patient has developed active tuberculosis and is prescribed isoniazid and rifampin. Which information will the nurse include in teaching the patient about taking these drugs? (Select all that apply.)
Isoniazid should be given 1 hour before or 2 hours after meals.
Have periodic eye examinations as ordered by the health care provider.
Compliance with drug regimen is essential.
Report numbness, tingling, and burning of hands and feet.
A middle-aged adult is diagnosed with tuberculosis. Which is true of treatment for this diagnosis?
A combination of drugs is typically used.
4 drugs- phase 1
2 drugs- phase 2
Which teaching for the patient who is taking fluconazole is a priority for the nurse?
Advise that hypoglycemia may occur with concurrent oral sulfonylureas.
When teaching a patient about isoniazid (INH) and rifampin drug therapy, which statement will the nurse include?
“Avoid exposure to direct sunlight.”
Take B6 to prevent neuropathy
A patient is diagnosed with a Candida infection in the mouth. The nurse anticipates that the patient will be treated with
nystatin.- PO or Topical
When caring for a patient receiving amphotericin B, it is most important for the nurse to assess the patient for the development of
hypokalemia. And hypomagnesemia
Immunity Types
Active immunity, Passive immunity, Community immunity
Which nursing intervention is the priority when a patient is receiving antiviral drugs?
Promoting hydration –renal function and elimination of drugs
Active immunity
Natural Active Immunity and Acquired Active Immunity
Natural Active Immunity
when antigen or pathogen enters the body.
Body produces antibodies to defend itself against antigen or pathogen
Acquired Active Immunity
When someone’s is given a vaccination where there is a weakened antigen or antibody given.
Passive immunity-
Natural Passive Immunity and Acquired Passive Immunity
HERD immunity.
Community immunity
Antibodies are given to someone that cannot make own antibody
Passive immunity
Acquired Passive Immunity
person given antibodies but not immune response occurs. Immunity is short lived and not term
Natural Passive Immunity
infant receiving breast milk
Majority of a community is immunized against something.
Community immunity
Immunocompromised are safe
Community immunity
Probability of acquiring the diseases is low due to community being immunized.
Community immunity
Small amount of an antigen.
Vaccination-
Antigen stimulates immune response but not producing disease.
Vaccination-
Traditional vaccines contain whole or parts of the killed microorganism
Ex. polio vaccine
Vaccination-
Live, weakened virus (microorganisms).
Attenuated virus
If someone is immunocompromised they should not receive.
Attenuated virus
Inactivated toxins that can no longer produce disease.
Toxoids-
Stimulate immune system to produce antitoxins which neutralize toxins.
Toxoids-
Seen in tetanus vaccine (tetanus toxoid)
Toxoids-
Protein or toxoid from unrelated organism added-helps attach to the outer coating of the disease causing organism.
Conjugate vaccines
Attenuated virus Ex:
measles mumps and rubella (MMR)
Required stimulation of immune response to immature immune system.
Conjugate vaccines
H influenzae type B vaccine preventing pneumonia
Conjugate vaccines
Genetic material of pathogen inserted into another cell or organism.
Recombinant subunit vaccines
Stimulates production of a lot of antigens.
Recombinant subunit vaccines
Antigens are used as a vaccine instead of whole organism Ex: Hep B
Recombinant subunit vaccines
Aluminum salt added to vaccine to increase body immune response.
Adjuvant
Help maintain immunity.
Can change to adapt to the virus. Ex: Flu, COVID-19
Booster
Reduce amount of antigen needed to produce a response
Adjuvant
Vaccination Recommendations: Advisory Committee on Immunizations (ACIP)-
who approves vaccination schedules
Vaccination Recommendations Most current info –
www.cdc.gov/vaccines
Centers for Disease Control and Prevention (CDC) vaccine information statement (VIS)-
information pamphlet given to client. Inform the client
Centers for Disease Control and Prevention (CDC) vaccine information statement (VIS) informs about
Route of administration
Schedule for routine administration
Minimum dosing intervals
Contraindications
Standing orders for administering vaccines
Immunization Before International Travel
MMR, Typhoid fever, Yellow fever, Meningococcal disease, Rabies, Hepatitis A and B, Japanese encephalitis
MMR
All travelers 6 months and older
Typhoid fever
India, Pakistan, Mexico, Bangladesh, Philippines, and Haiti
Yellow fever
sub-Saharan Africa and tropical South America
Educate pts if travel need to have
Primary Care Provider Appointment
Vaccine Safety- Reporting diseases and adverse reactions
Mild reactions, Contraindications, HC providers, VAERS
Injection site swelling, low grade fever, redness to area.
Mild reactions-
Tx; with acetaminophen, warm compress, Benadryl.
Mild reactions-
Do not take acetaminophen or ibuprofen before a vaccine bc it can reduce immune response.
Mild reactions-
To well educate before refusing vaccine.
Contraindications for vaccines-
Moderate to severe illness.
Contraindications for vaccines-
Anaphylactic history response to vaccine.
Contraindications for vaccines-
Vaccines contra during pregnancy.
Contraindications for vaccines-
Generally save to give vaccine if they have illness and still taking antibiotics
Contraindications for vaccines-
Health care providers responsible for
reporting vaccine preventable adverse effects
Surveillance system that keeps tracks of adverse events that occur on vaccine.
Determined efficacy and safety of the vaccine
Report adverse reactions to VAERS-
Vaccines in general are safe to protect from
life threatening disease
Varicella vaccine Side effects/adverse reactions
Injection site reaction, fever, rash, anaphylaxis
Thrombocytopenia, encephalitis, Stevens-Johnson syndrome
Varicella vaccine Contraindications
Moderate to severe acute illness, anaphylaxis
Active untreated tuberculosis, pregnancy
High-dose systemic steroids, immunocompromised
If given with other vaccines it needs to be given at a separate site.
Varicella vaccine Drug interactions-
Live- MMR must be separated by 4 weeks.
Varicella vaccine Drug interactions-
Contra- blood transfusion within the last 11 months.
Varicella vaccine Drug interactions-
Blood products should be avoided for 2 months after vaccine bc don’t want to interfere with antigen process.
Varicella vaccine Drug interactions-
Live vaccine- developed in 1995. the illness rate declined by 75%
Varicella vaccine
Before that 4 million got chicken pox bc not vaccine
Varicella vaccine
Prototype
Varicella vaccine
An adult exposed to chickenpox 20x more likely to die than a child
Varicella vaccine
Bacillus anthracis- infect skin, GI tract and lungs.
Anthrax-
See skin blistering with swelling around it.
Anthrax-
GI tract- N/V, diarrhea and abdominal pain.
Anthrax-
Lungs- fever chest pain SOB.
Anthrax-
Spread from animals to people.
Anthrax-
Vaccine developed in 1970 and usually given to lab and military personal, livestock farmers and vets.
Anthrax-
Can be used as biological weapon
Anthrax-
Vareolia virus causes.
Smallpox-
S/sx fever chill body aches malaise vomiting.
Smallpox-
delclared eradicated world wide in 1977.
Smallpox-
Children no longer getting vaccine.
Smallpox-
Does still exist in the lab. Biological weapon
Smallpox-
bordetella pertussis.
Pertussis(whooping cough)-
runny nose congestion, red waterly eyes, low grade fever, uncontrllabe cough.
Pertussis(whooping cough)-
Adlosenesce and adults can transmit this to infants and children which cause death in them.
Pertussis(whooping cough)-
If pregnant the must be aware about other people vaccines.
Pertussis(whooping cough)-
Given as childhood vaccine with boosters (TDAP)
Pertussis(whooping cough)-
DTAP-(6w to 6yrsof age)
Pertussis(whooping cough)-
Shingles, caused by varicella zoster virus.
Herpes zoster-
After infection with check pox remains dormant.
Herpes zoster-
Results in decline immunity.
Herpes zoster-
Live vaccine <50yrs of age recommended.
Herpes zoster-
50% effective in trials
Herpes zoster-
Leading cause of severe Gasteroenteritis in children and infants.
Rotavirus-
Watery dia, dehydration, vomiting.
Rotavirus-
Live oral acting which contains 5 strands of rotavirus
Rotavirus-
3 dose serious before 8 months of age.
Rotavirus-
HPV.
Human papillomavirus-
STD causes genital warts and cancer.
Human papillomavirus-
2 approved vaccines given between 9 and 26 years of age.
Human papillomavirus-
Most effective if given before first indication of sexual intercourse.
Human papillomavirus-
Protecting against multiple strains of streptococcus pneumonia which causes pneumonia.
Pneumococci-
2 forms of vaccine available.
Pneumococci-
Should be given to high risk individual between 2-65yrs.
Pneumococci-
Repeated every 5 years.
Pneumococci-
Prevent infections that effect the brain and blood that causes death in pneumococcal infection
Pneumococci-
Live threatening infection that can cause brain damage, hearing loss, amputation and loss of kidney function.
Bacterial meningitis-
Lot of bacteria that causes it.
Bacterial meningitis-
Several vaccines available, Advisory Committee on Immunization Practices
(ACIP) routine vaccination everyone ages 2-55.
Bacterial meningitis-
College age must get this vaccine
Bacterial meningitis-
Vaccines Nursing Interventions-
Must document vaccination date route site of administration, vaccine type, manufacture, lot number, expiration date, address of where the person is getting the vaccine, time, signature of giving the vaccine.
Monitor pt if first time.
Keep epinephrine for immediate use for reactions.
Vaccines Education-
Provide vaccination form in preferred language.
Newborns receive immunities via the transfer of maternal antibodies across the placenta. This is known as
natural, passive immunity.
Which statement about the Herpes Zoster vaccine does the nurse identify as being true? Herpes zoster vaccine
is a live attenuated vaccine.
Which is the first vaccine developed to prevent cancer?
Human papillomavirus
Vaccines Assessment-
health and drug history, allergies, determine pregnancy history possibility within the next month so no contraindications. Immunization history so not giving too many vaccines
