Pharm Exam #1: Antibiotics Flashcards
Antibacterial
Penicillin
What does Penicillin treat
Broad-spectrum infections
What type of antibiotic is penicillin?
beta-lactam
What acid is given to help penicillin treat resistant bacteria?
Clavulanic acid
What is the prototype antibacterial?
Amoxicillin
What does penicillin do to bacteria?
Weakens and destroys bacterial cell walls
Adverse Penicillin reactions?
-GI upset
-Superinfections
-Allergic reactions (rash, hives, anaphylaxis)
-Anaphylactic shock (swelling, wheezing, difficulty breathing)
Penicillin Interventions
-Monitor GI symptoms (take with food)
-Watch for allergic reactions
-Observe client for 30 minutes
Penicillin Instructions
-Report severe diarrhea (bloody or watery)
-Take with meals
-Report pain, inability to eat, vaginal itching/discharge
-Call 9/11 wheezing, airway swelling, breathing difficulty
Penicillin Contraindications
-known penicillin allergy
-hypersensitivity to procaine or benzathine
-Severe renal impairment
-Oral contraceptives (penicillin may reduce effectiveness)
What type of antibiotic is Cephalosporin?
beta-lactam antibiotic
What effect does cephalosporin have?
broad-spectrum effect
Why 5 generations of Cephalosporins?
Each generation has increased effectiveness against gram-negative bacteria and better resistance to beta-lactamase
What is the prototype Cephalosporin?
-Cephalexin (1st gen)
Generations of Cephalexin?
- Cefazolin
- Cefoxitin
- Cefotaxime
- Cefepime
- Ceftaroline (effective against MRSA)
Pharmacological Action of Cephalosporins
Work similar to penicillins
1. Inhibit transpeptidase (cell wall formation)
2. Activate autolysin (weakening the bact cell wall)
-Cephalosporins are bacterial and effective against aerobic gram-positive and gram-negative bacteria
Cephalosporin adverse reactions
-GI upset (nausea, vomiting, diarrhea)
-C DIFF-ASSOCIATED DIARRHEA (CDAD)
-Allergic reactions (rash, hives, anaphylaxis)
-THROMBOPHELBITIS (IV site irritation)
Cephalosporin Interventions
-Monitor for CDAD (report bloody/watery stools)
-Assess for PENICILLIN allergy
-IV admin site monitoring
-Monitor renal function
Cephalosporin Client ED
-Cephalosporin allergy
-Penicillin allergy
-RENAL FAILURE
What type of antibiotic are Monobactams
Narrow-spectrum beta-lactam antibiotics
Why are Monobactams good for those with Penicillin allergy?
-No cross-reactivity with beta-lactam antibiotics
Prototype Monobactam
Aztreonam
Monobactam Pharmacological Action
- Inhibit transpeptidase, preventing cell wall formation
- Activate autolysin, leading to bacterial cell death
-They are bactericidal but only effective against aerobic gram-negative bacteria
Monobactam Adverse Reactions
-IV site irritation
-GI upset
-Superinfections: C. diff risk
-Always asses for anaphylaxis and bowel function
Monobactam Interventions
-Monitor IV site
-Monitory for C. diff infections
Monobactam Admin
-IM: rotate injection sites
-IV: admin slowly
Monobactam Client Instructions
-Report pain, redness, swelling at IV site
Monobactam Contraindications
-RENAL IMPAIRMENT
-OLDER ADULTS (increased risk of side effects)
Monobactam Interactions
Incompatible with IV meds
What type of antibiotic are Carbapenems
-Broad-spectrum antibiotics
-Used for severe infections
-USE ONLY WHEN OTHER ANTIBIOTICS ARE INEFFECTIVE TO PREVENT RESISTENCE DEVELOPMENT
Prototype Carbapenem
Imipenem + Cilastatin
-Other: Meropenem
Carbapenem Admin Route
-IM or IV ONLY
-Not absorbed in GI tract
Carbapenem Pharmacological Action
- Inhibit transpeptidase (cell wall formation)
- Activate autolysin, causing bacterial destruction
-They are bactericidal against gram-positive cocci, gram-negative bacilli, and anaerobic bacteria
Carbapenem Adverse Reactions
-GI Issues (worse if infused too rapidly)
-IV site (thrombophlebitis)
-Allergic reactions (cross-sensitivity with penicillins and cephalosporins)
-Superinfections (candida, C. diff)
-SEIZURES: INCREASED RISK ESP W RENAL IMPAIRMENT
-LIMIT TO 10 DAYS TO PREVENT SERIOUS SIDE EFFECTS
Carbapenem Interventions
-Admin IV slowly to reduce nausea/vomiting
-Monitor IV site
-MONITOR RENTAL FUNCTION AND SEIZURE HIST
Carbapenem Admin
-Admin IV slowly to prevent GI symptoms
Carbapenem Contraindications
-Carbapenem or penicillin allergy
-Hist of severe cephalosporin allergy
-SEIZURE DISORDERS
-RENAL IMPAIRMENT
Vancomycin Antibiotic use
non-beta-lactam antibiotic
Treats:
-Gram-positive
-MRSA**
Vancomycin Prototype
Vancomycin is the prototype
Vancomycin Expected Pharmacological Action
- Inhibits transpeptidase, preventing cell wall formation
- Activates autolysin, wakening bacterial cell wall
Vancomycin is bactericidal against gram-positive bacteria
Vancomycin Adverse Reactions
-Renal Failure (major toxic concern)
-“Vancomycin Infusion Reaction” (tachycardia, hypotension, rash, pruritus, flushing)
-Ototoxicity (rate but possible, usually reversible)
-IV sit irritation
Vancomycin Interventions
-Admin over 60min (prevents infusion reaction)
-Monitor VS during infusion
-Check trough levels before next dose
-Monitor BUN and Creatinine
-Assess for superinfections (C. diff, oral/vaginal candida)
-Watch for Ototoxicity
Vancomycin Admin
-IV for systemic infections: INFUSE OVER 60 MINUTES
-Oral for C. diff (not absorbed systemically)
Vancomycin Client ED
-Report facial flushing, dizziness, or difficulty breathing during infusion
-Monitory urine output (sign of kidney dysfunction)
-Reporting ringing in ear, or hearing loss
Vancomycin Contraindications
-Vancomycin allergy
-RENAL IMPAIRMENT
-HEARING IMPAIRMENT
Vancomycin Interactions
-Ototoxic/nephrotoxic drugs (aminoglycosides, NSAIDs, loop diuretics)
Lipoglycopeptides Use
-gram-positive bacterial infections
-Skin infections and pneumonia (when vancomycin is ineffective
Lipoglycopeptides Prototype Drug
-Telavancin (IV only)
Lipoglycopeptides Pharmacological Action
-Effective against MRSA and Vancomycin-resistant strains
Lipoglycopeptides Adverse Reactions
-Nausea, vomiting
-PROLONGED QT INTERVAL
-INFUSION REACTION
-INCREASED MORTAILITY RISK IN CLIENTS WITH MODERATE-SEVERE RENAL IMPAIRMENT
Lipoglycopeptide Interventions
-MONITOR INFUSION REACTIONS
-CHECK RENAL FUNCTION BEFORE AND DRUING TREATMENT
-MONITOR ECG FOR QT PROLONGATION
-PERFOMR PREG TESTING (risk of fetal harm)
Lipoglycopeptide Admin
-IV only (once daily over 60 min)
-Don’t infuse too rapidly
Lipoglycopeptide Client ED
-Report rash, hives, skin color changes
-Monitor for GI upset
-Women should use contraceptives
Lipoglycopeptide Contraindications
-Long QT syndrome
-Severe left ventricular hypertrophy
-Heart Failure
-Pregnancy
RENAL IMPAIRMENT
CURRENT IV HEPARIN USE (affects aPTT tests)
Lipoglycopeptide Interactions
-Anticoagulants
-ACE inhibitors NSAIDs, loop diuretics (increase renal damage risk)
-Meds that prolong QT (fluoroquinolones, SSRIs)
What type of antibiotic is Tetracycline
Inhibits protein synthesis
What do Tetracyclines Treat
-Chlamydia, mycoplasma, rickettsial infection (typhus, Rocky Mountain spotted fever)
-Syphilis in penicillin-allergic clients
Tetracycline Prototype
-Tetracycline
Other meds: Doxycycline, Minocycline
Tetracycline Pharmacological Action
- Inhibit bacterial protein synthesis by preventing tRNA binding
- Bacteriostatic (prevents bact growth)
Tetracycline Adverse Reactions
-GI upset
-Liver toxicity
-Superinfections (C. diff, Candida)
-Photosensitivity
-PERMANENTLY STAIN DEVELOPING TEETH (no use under 8yo)
Tetracycline Interventions
-Give on empty stomach for increase absorption
-Avoid dairy, calcium antacids and iron supplements (decrease effectiveness)
-Assess for liver dysfunction
-Check for photosensitivity reactions
Tetracycline Admin
-On empty stomach
-Do NOT give before bed (esophageal irritation risk)
Tetracycline Client ED
-Take on empty stomach
-AVOID dairy, antacids and iron
-Use sunscreen (high burn risk)
Tetracycline Contraindications
-Pregnant clients (risk to fetus)
-Children under 8yo (tooth discoloration)
-Liver/kidney impairment
-Oral contraceptives (reduced effectiveness)
What do Macrolides do
-Inhibit protein Synthesis
What do Macrolides treat
-Legionnaires’ disease, whooping cough, diphtheria
-Neonatal eye infections
Macrolide prototype
-Erythromycin
Macrolides Pharm Action
-Inhibit bacterial protein synthesis
-Bacteriostatic (prevents bact growth)
Macrolide Adverse Reaction
-GI upset
-QT prolongation
-Ototoxicity
-Superinfections (C. diff, Candida)
MACROLIDES INCREASE RISK OF CARDIAC ARRYTHMIAS (torsades de pointes)
Macrolide Interventions
-Monitor GI distress
-ASSESS ECG for QT PROLONGATION
-Monitor for ototoxicity
-Check for superinfections
Macrolide Admin
-Take erythromycin on empty stomach (1-2hrs before meals)
-Drink with 8oz water
Macrolides Client ED
-Report heart palpitations, fainting, dizziness
Macrolides Contraindications
-Hist of long QT syndrome
-LIVER DISEASE
-ELECTROLYTE IMBALANCE (hypokalemia, hypomagnesemia)
Macrolides Interactions
Increases levels of warfarin, theophylline, digoxin
What does Aminoglycosides do
-Inhibit protein syntheis
What are Aminoglycosides
-narrow-spectrum antibiotics
-Treat serious infections caused by aerobic gram-negative bacteria
Aminoglycosides Prototype
Gentamicin
Aminoglycosides Pharm Action
- Inhibit protein synthesis by interfering with bacterial RNA
- Bactericidal (higher doses kill bacteria faster)
Aminoglycosides Adverse Reactions
-OTOTOXICITY
-NEPHROTOXICITY
-THROMBOPHELBITIS at IV site
-NEUROMUSCULAR BLOCKADE
Aminoglycosides Interventions
-Monitor for tinnitus, vertigo, hearing loss
-Check kidney function
-Monitor peak and trough levels
-Ensure adequate hydration to reduce nephrotoxicity risk
Aminoglycosides Admin
-IM deep into large muscle
-IV slow over 30-60min
-Monitor peak (30 min after dose) and trough (1hr before next dose)
Aminoglycosides Client ED
-Report tinnitus, hearing loss, dizziness, vertigo
-Monitor urine output
Aminoglycosides Contraindications
-Hearing loss, tinnitus, or vestibular disorders
-Myasthenia gravis or neuromuscular disorders
-Kidney disease or dehydration
-PREGNANT CLIENTS: RISK OF CONGENITAL DEAFNESS IN FETUS
Aminoglycosides Interactions
-Ototoxic and Nephrotoxic drugs (vancomycin, NSAIDs, loop diuretics)
What do Oxazolidinones do
Inhibit protein synthesis
What do oxazolidinones treat
-Broad-spectrum antibiotics
-MRSA**
-VRE**
Oxazolidinones Prototype
-Linezolid
Oxazolidinones Pharm Action
- Block bacterial protein synthesis by binding to ribosomes
- Effective against resistant gram-positive bact (MRSA, VRE)
Oxazolidinones Adverse Reactions
-Headache
-GI upset
-ANEMIA (LOW RBC COUNT)
-PERIPHERAL NEUROPATY (long term use)
-SERINTONIN SYDNROME (if taken with SSRIs)
-DO NOT GIVE TO CLIENTS TAKING MAO INHIBITORS
Oxazolidinones Interventions
-Monitor CBC weekly (watch for anemia)
-Assess for signs of serotonin syndrome
-Check for neuropathy
-Monitor Na+ levels (risk of hyponatremia)
Oxazolidinones Admin
-IV form: infuse slowly
-Oral: contains phenylalanine (monitor clients with phenylketonuria)
Oxazolidinones Client ED
-Avoid foods high in tyramine (aged cheese, dried meats, red wine)
-Monitor blood sugar if diabetic
Oxazolidinones Contraindications
-Use of MAO inhibitors in last 2wks
-UNCONTROLLED HYPERTENSION
-Older adults: risk of neuropathy and lactic acidosis
-RENAL OR LIVER IMPAIRMENT
How do Fluoroquinolones work
Inhibit DNA replication/cell division
What do fluoroquinolones treat
-Serious bacteria infections:
Severe UTIs
Anthrax exposure
AVOID IN CHILDREN UNDER 18yo, RISK OF ACHILLES RUPTURE
Fluoroquinolone Prototype
-Ciprofloxacin
Other: Levofloxacin
Fluoroquinolones Pharm Action
- Inhibit bacterial DNA replication
- Bactericidal
Fluoroquinolones Adverse Reactions
-GI upset
-CNA EFFECTS (dizziness, headache, confusion in elderly)
-ACHILLES TENDON RUPTURE
-PHOTOSENSITIVITY (severe sunburn)
-QT PROLONGATION
Fluoroquinolones Interventions
-MONITOR FOR CNS EFFECTS
-ACCESS FOR TENDON PAIN (stop immediately if pain occurs)
-Use sun protection
-Monitor ECG (QT prolongation)
Fluoroquinolones Admin
-IV form: infuse over at least 60 min
Fluoroquinolones Client ED
-Avoid direct sun exposure
Fluoroquinolones Contraindications
-Tendon pain/hist of ruptures
-QT prolongation
-CNS disorders-depression, seizures (risk of exacerbation)
What do Sulfonamides do
Inhibit folic acid synthesis
What do Sulfonamides treat
-Broad-spectrum synthetic antibiotic
-Treats:
UTIs
Pneumocystis pneumonia
Traveler’s diarrhea
Acute exacerbation of chronic bronchitis
Acute otitis media in children
Sulfonamides Prototype
-Sulfamethoxazole-trimethoprim (Bactrim)
-Other: Sulfadiazine
Sulfonamide Pharm Action
- Block folic acid synthesis
- Bacteriostatic
Sulfonamide Adverse Reactions
-GI upset
-HYPERSENSITIVITY REACTIONS (Stevens-Johnson syndrome)
-Blood disorders
-Crystalluria
-Super infections
-Photosensitivity
Sulfonamides Interventions
-Encourage 1.2L-1.5L fluid per day
-Monitor CBC for blood disorders
-Assess for rash or hives
Sulfonamides Admin
-Oral: take with 8oz water
Sulfonamide Client ED
-Drink plenty of water to prevent kidney damage
-Take with food
-Report any rash
-Avoid prolonged sun exposure
Sulfonamide Contraindications
-Pregnancy, breastfeeding infants less than 2mo
-Severe renal of liver impairment
-Megaloblastic anemia (folic acid deficiency)
-Sulfa allergy or cross-sensitivity to similar drugs e.g. THIAZIDE DIRUETICS, CELECOXIB
Sulfonamide Interactions
-Alcohol (GI upset)
-Warfarin, phenytoin, oral hypoglycemics (increase risk of bleeding and toxicity)
What do Urinary Tract Antiseptics do?
-Inhibit folic acid synthesis
-Specifically treat and prevent UTIs by directly targeting bacteria in the urinary tract
Urinary Tract Antiseptic Prototype
Nitrofurantoin (Macrobid, Macrodantin)
Urinary tract antiseptic Pharm Action
-Bacteriostatic or bactericidal depending on dose
UTI drug Adverse Reaction
-GI upset
-TURN PEE ORANGE
-PULMONARY REACTIONS (fever, cough, dyspnea) can become permanent lung damage (fibrosis) if the drug is not stopped
UTI drug Interventions
-Monitor and report resp symptoms immediately
-Encourage adequate hydration to prevent kidney damage
UTI drug Admin
-Take with food or milk to reduce GI upset
-Expect orange pee
UTI drug contraindications
-Pregnancy in last 4wks
-Newborns less than 1 month (risk of hemolytic anemia)
-Liver disease or electrolyte imbalance
Safety Alert: Aminoglycosides
-Ototoxicity
-Nephrotoxicity (monitory trough levels, BUN, creatinine)
Safety Alert: Oxazolidinones
-Serotonin syndrome
AVOID SSRIs and MAOIs
Safety Alert: Fluoroquinolones
-Tendon rupture
-Avoid in children, elderly, steroid users
Safety Alert: Sulfonamides
-Stevens-Johnson syndrome
Safety Alert: Urinary Antispetics
-Pulmonary fibrosis
-Monitor for persistent cough, dyspnea
