treatment of infection part 2 Flashcards
what are macrolides used for
- penicllin sub
name some macrolides
- erythromycin
- azithromycin
- clrithromycin
- fidaxomicin
what are some adverse reactions of macrolides
black box warning for caution with use in patients wit liver disease, can cause hepatotoxicity
- GI: pseudomembraneous colitis
- CNS: reversible hearing loss, confusion
- cardiac: can alter cardiac conduction, prolong QT interval, and cause a lethal rhythm
what are some contraindications/cautions for macrolides
- liver disease
- inflammatory bowel disease
- numerous drug interactions: warfarin and digoxin (macrolides cause slow increase in serum level and are more likely to cause adverse effects and toxicity)
- do not use if patient is on fluconazole and/or diltiazem , can cause cardiac death
what are some nursing considerations for macrolides
- antacids reduce absorption
- assess meds patient is receiving for interactions
describe clindamycin
(not.a macrolide)
- topical for staph infections
- systemic for very serious infections
black box warning for fatal pseudomembraneous colitis
name a lipoglycopeptides
vancomycin
lipoglycopeptides
what are some uses of vancomycin
- not many due to VRE
- PO treats cdiff
- MRSA (prophylactic or tx)
lipoglycopeptides
whats important to remember about vancomycin
- nephrotoxic (draw trough before 4th dose)
- IV is vesicant/irritant (may recommend central line if given over 2-3 days)
- red man syndrome (if given too quickly… rash on face, neck, and trunk may occur)
oxazolidinone
describe linezolid and its use
- not used for long term therapy
- serious hematologic and neurologic complications
- used for VRSA
oxazolidinone
what are some adverse effects of linezolid
- bone marrow depression: can occur if given longer then 2 weeks, cause anemia, neutropenia, pancytopenia, and thrombocytopenia
black box warning: interferes with breakdown of serotnin in the brain, if given with SSRIs, SNRIs, TCAs, MAOIs it can cause serotonin syndrome
oxazolidinone
what are some nursing considerations for linezolid
- serotonin syndrome
- CBC monitoring
- remember your patients with psych issues will be off of there psych meds
what are some signs of serotonin syndrome
muscle twitching, excessive sweating, shivering, shaking, fever, diarrhea
what are some adverse effects of chloramphenicol
- black box warning: hospitalization is recommended
- reported to cause aplastic anemia that is irreversible and deplete bone marrow
what lab is important to check frequently when giving chloramphenicol
CBC
describe daptomycin
- used for complicated skin and skin structure infections
- also used for bacteremia caused by S. aureus
- often used with gentamicin
what drug should you use with caution with daptomycin and why
statins
risk of musculoskeletal complications
your patient is receiving IV vacomycin and develops a rash on the face, neck, and trunk. what is the nurses priority action?
slow down the infusion
red man syndrome is associated with giving the med too quickly
the nurse should question the combo of which two meds?
1) daptomycin and gentamicin
2) diltiazem and erythromycin
3) azithromycin and gentamicin
4) vancomycin and rifaximin
2) diltiazem and erythromycin
macrolides and diltiazem can lead to cardiac arrest
name some sulfonamides
- trimethropim-sulfamethoxazole (bactrim)
- sulfadiazine
- sulfasalazine
- sulfisoxazole
what are some adverse effects of sulfonamides
- hypersensitivity reacions common
- GI: risk of pancreatitis
- renal
- hematologic: risk for thrombocyopenia, leukopenia, aplastic anemia
- dermatological: itching, skin photosensitivity, steven-johnson syndrome
what are some contraindications/cautions with sulfonamides
- allergies to sulfa drugs or thiazide diuretics
- megaloblastic anemia
- renal disease
- elderly (increased risk of developing hyperkalemia)
- infants <2mo
- pregnancy
what are some nursing considerations for sulfonamides
- CBC monitoring
- BMP in elderly
- sulfasalazine can stain skin
name some tetracyclines
- tetracycline
- doxycycline
- minocycline
what are some nursing considerations for tetracyclines
- administer on empty stomach with lots of water
- remain upright for 30mins
- throw outdated meds away (can cause renal failure)
- many drug and food interactions: antacids, iron, dairy, digoxin (enhance dig effects), anticoagulants (decrease in effectiveness)
what are some adverse effects of tetracyclines
- GI (can cause esophagitis if not upright for 30mins afterwards)
- dental (can cause permanent yellowing/browning of teeth)
- skeletal (harm bone growth)
- derm (severe skin photosensitivity)
what are some cautions/contraindications of tetracyclines
- pregnancy/lactating
- children <8years
- hepatic/renal dysfunction
urinary antiseptics
describe phenazopyridine (pyridium)
- most commonly used
- urinary analgesic (provides relief of burning and itching of lower urinary tract)
- give with food
- reddish/orange urine
- no UA, only C&S
- black box warning: med can accumulate in system and skin may appear yellow)
- do not take more than two days (can lead to renal failure)
the nurse knows an adverse reaction to doxycycline is which of the following?
1) esophagitis
2) prolonged QT interval
3) pseudomembraneous colitis
4) anemia
1) esophagitis
tetracyclines have an adverse effect of causing esophagitis is not taken properly
describe tuberculosis
- tuberculosis affects primarily the lungs
- may also affect lymph, pleura, GI, bones/joints, kidneys, and brain
- leading cause of death worldwide for people with HIV
- multi-drug resistant TB (MDR-TB) is a MAJOR CONCERN
what is the causitive agent in TB and describe it a little
mycobacterium tuberculosis
- clow growing bacteria
- lays dormant
- different types of mycobacteria
- found in water and soil
- airborne transmission
what are the four phases of TB
- transmission
- primary infection
- latent TB infection
- active TB
describe transmission of TB
when the person inhales infected airborne droplets
describe primary infection of TB
- 2-10 weeks after transmission
- mild flu-like symptoms
- often undiagnosed at this point
describe latent TB infection
- immune system has stopped bacterial growth and they become inactive but may become active later on
- no symptoms and do not spread to others
how might a person with latent TB develop active TB?
- further exposure to TB
- reactivation due to weakened immune system
describe active TB
- only 5-10% of people develop active when first infected
- lungs are common site of infection
what are the clinical manifestions of TB
- low grade fever
- cough
- fatigue
- weight loss
- night sweats
- hemoptysis
what digonostic tests are used for TB
- mantoux skin test (can give false positives if vaccinated)
- quantiferon-tb gold (blood test, preferred ove skin test)
- chest xray (gold standard for actual diagnosis)
- sputum cultures
describe drug therapy for TB
- used to treat both latent TB (in patients at higher risk) and active TB
- 10 drugs appoved by FDA
- four treatment regimens approved for treatment of latent TB
- first line of anti-TB drugs used in combination therapy: izoniazid (INH), rifampin (RIF) , ethambutol (EMB), pyrazinamide (PZA)
prior to startign therapy for TB, what should be included in patient teaching
- should start feeling better 2-3 weeks
- direct observational therapy (used with possible noncompliance)
- highly individualized therapy
- report adverse symptoms (liver toxicity and peripheral neuropathy)
- educated on how disease is spread and what latent TB is
what are some adverse effects of isoniazid (INH)
- CNS: seizures
- GI: pancratitis
- black box warning for liver toxicity: RUQ pain, no appetitie, jaundice, peripheral neuropathy
what are some cautions/contraindications of isoniazid (INH)
- hepatic/renal dysfunction
- CNS dysfunction
what are some adverse effects of rifampin
- skin: skin, tears, urine, sweat, and contacts stain a reddish/orange color
- GI
- renal: renal injury
what are some contraindications/cautions of rifampin
- hepatic dysfunction or history of alcoholism (hard on the liver)
- being treated for HIV (HIV meds interfere with TB ones)
- pregnancy/lactation
what two drugs are adjuvant first line drugs for first two months of treatment
pyrazinamide (PZA) and ethambutol
what are some adverse effects of pyrazinamide (PZA)
- GI upset
- hyperuricemia (stop gout tx before starting this med)
- hepatotoxicity
whats an adverse effects of ethambutol
optic neuritis (color blindness)
